Morbid anatomy and pathology of lateral curvature of the spine : an expansion of a note published in The Lancet of September 24 1904 / by Geo. Steele-Perkins, M.D.

  • Steele-Perkins, George
Date:
[1904?]
Catalogue details

Licence: In copyright

Credit: Morbid anatomy and pathology of lateral curvature of the spine : an expansion of a note published in The Lancet of September 24 1904 / by Geo. Steele-Perkins, M.D. Source: Wellcome Collection.

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    of the right arm then the dorsal curvature would be primary and the lumbar secondary, whereas on the other hand if the determining factor be due to the fact that one leg is shorter than the other the lumbar curve will be primary and the dorsal curve secondary. In many cases it is very difficult to determine which of two curves is primary, nevertheless no trouble should be spared in endeavouring to form a correct diagnosis on the point. The importance of it lies in the fact that in treating the case it is the secondary curve that first disappears, although at the same time a reduction in the primary curve is taking place and it is the primary curve that is straightened last. We have first, therefore, to direct our main attention to the reduction of the secondary curve and when this has been rectified we can bring our energies to bear on the straighten¬ ing of what remains of the primary curve. To decide which curve is the primary one and which the secondary a careful investigation as to the cause, particularly as to what is the determining factor, is of the greatest importance, as the cause of the deformity will in a large number of cases enable us to decide at once which is the primary curve. Then, again, the primary curve is generally greater than the secondary, although sometimes the secondary curve has increased beyond that of the primary curve, in which case you will often find a third curve which is really com¬ pensatory to the second curve, and in the treatment of such a case the third curve must receive the greatest attention at first, then the second curve, and, finally, what then remains of the primary curve. A third curve may, of course, occur, and often does, without the secondary curve becoming greater than the primary curve, but nevertheless it is compensating to the secondary curve. The primary curve may be in the cervical, dorsal, or lumbar region, most usually it is in the dorsal region, but primary lumbar curves frequently occur, being caused by one leg being shorter than the other or a tilting of the pelvis to one side. It is to be noticed that a shortening of one leg does not necessarily, although it does usually, result in a lumbar curve with the convexity on the side of the shorter leg, as one would expect, but that sometimes the convexity of the lumbar curve is on the opposite side to that of the shortened leg. The pathology of this is obscure but the fact remains. A compensating curve is naturally always on the opposite side to the curve which it compensates. A dorsal curve is not always compensated by a lumbar curve but sometimes by a curve lower down in the dorsal or else in the dorso- lumbar region. Doubtless sometimes two curves may occur at the same time, but at any rate this is very unusual and generally a careful investigation will enable one to discover that one curve preceded the other, if only by a short time. The compensating secondary curve is always more easily corrected than the primary curve. Wimpole-street, W. Printed at The Lancet Office, 423, Strand, W.C.
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