Early laminectomy for spinal cord injury not due to subluxation

Abstract

About a hundred years ago, Sir Astley Cooper and Sir Charles Be11 were debating the value of Iaminectomy in spina cord injury. Since then, the penduIum of opinion has swung back and forth between conservative treatment or operative intervention in these cases. At the moment most neurosurgeons are not enthusiastic over Iaminectomy in spina cord injuries; neuroIogists, on the other hand, have frequentIy beIieved that their overcautious attitude is, in many cases, not justified. From the experimental standpoint, the onIy work we were abIe to find in the Iiterature was that of AIIenl (1908 to 191 I) which, unfortunateIy, has not been given the attention we beIieve this vaIuabIe contribution merits. AIIen produced spina cord injuries in dogs by means of an instrument whereby a given weight couId be dropped from a known height to produce a given impact. Laminectomy was first performed in the Iower third of the thoracic region of anesthetized dogs. The instrument was then pIaced in position and the weight dropped on the cord. The resuIting impact in Gram-centimeters was the product of the height in centimeters and the weight in Grams. As soon as an impact of 340 Gm/Cm was exceeded, spastic parapIegias were produced, which did not cIear up spontaneousIy in the course of ten days as had the resuIts of impacts of Iesser severity. An impact of 450 Gm/‘Cm produced a picture of compIete transverse Iesion of the spina cord resuIting in the death of the anima1 in the asthenictoxic state famiIiar to a11 with experience of severe spina cord injuries in the human subject. In an attempt to determine whether this cessation of function was due to destruction of axis cyIinders directly consequent to the impact, or secondarily foIlowing edema and hemorrhage into the cord tissue, which by its pressure and chemica1 activity resuIted in uItimate cord degeneration, AIIen made Iongitudinal section into the cord immediateIy after these injuries were produced. In the cases in which such incision was performed, the dogs made either a compIete recovery or retained onIy sIight awkwardness in the hind Iimbs, not enough to prevent running or jumping. Without operation, this impact wouId have resuIted in the animaI’s death. From these experiments Allen believed that, in cases of fracture-disIocation of the spinal column in humans, in which