2 Anatomy of the Spinal Cord and Nerve Roots

This paper concerns oniy the immediate treatment of paraplegia from fracturedislocations of the spine at the thoraco-lumbar level. It is based on experience gained in the treatment of sixty-eight patients of whom forty-seven were treated by us from the beginning and twenty-one were admitted to the paraplegic centre several weeks or months after injury. From this experience we have reached certain conclusions about the immediate treatment of thoraco-lumbar injuries, developing as evidence accumulated, so that some patients seen in earlier years were not treated as they would be now. In this series there are so many varied factors that we have made no attempt to present our observations statistically. Most paraplegic patients die as a result of large bed sores and urinary tract infection, many of them as the result of inefficient treatment. Moreover, bad initial treatment results in a host of other complications such as gross angulation of the spine, stiffness of joints, contractures and deformities, which seriously delay or even prevent late rehabilitation. Early treatment must be designed to prevent these complications, to assist the establishment of compensatory mechanisms, and to promote every possible recovery of nerve function.