Tubercular conditions of the spine requiring surgical and mechanical relief / by De Forest Willard.

  • Willard de Forest
Date:
1905
Catalogue details

Licence: In copyright

Credit: Tubercular conditions of the spine requiring surgical and mechanical relief / by De Forest Willard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    diminution of caliber and the interference with nerve trans- mission are due to the first-named causes, while in only 2 per cent, is compression due to bony pressure. This fact is readily appreciated when it is noted that some of the worst cases of spinal caries paraplegia are those in which the kypho- sis is moderate or even small, and again that paralysis is absent in cases of most marked posterior angularity. The region of the spine most prone to yield the paraplegic complication of spinal caries is the upper dorsal, where the bony canal is limited in size, and where even a small amount of intraspinal deposit yields most serious consequences. The clinical experience of every surgeon, however, has taught him that even a severe grade of paraplegia may recover, although great angularity still exists, provided the tubercular and inflammatory deposits are absorbed. The amount of paralysis and the consequent symptoms will depend upon the position, extent, and character of the tubercular deposit. A child affected with spinal caries begins suddenly or slowly to show evidences of feeble locomo- tion; loss of sensation; increased knee-jerks and ankle clonus; rigidity of limbs; gradual contraction of some group of mus- cles; frequently, loss of control of sphincters of bladder and rectum; sometimes priapism, persistent and painful. Fifteen or twenty years ago the exceptionally good results secured in a few cases by Macewen, Horsley, Lauenstein, and others, encouraged us to hope that in laminectomy we had found a speedy method of relief. Unfortunately, larger and fuller personal experience has demonstrated that while a few cases are permanently benefited by operation, yet that the mortality is high, and, even when temporary improvement takes place, relapses were common and permanent benefit uncertain. The operation, therefore, while it has not been abandoned, has, like trephining of the cranium for epilepsy, been limited in its application and made secondary to other measures. Those measures have for their object the arrest and lessening and limitation of the bony destructive process and the perma- nent bridging and repair of the destroyed vertebral bodies. Added to these should be the employment of all the hygienic
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