The role of fusion or wiring in the treatment of acute traumatic instability of the spine.

Abstract

A review and analysis of the records of 583 patients who had been admitted to my private care at the Boston City Hospital over 30 years are analysed and classified in the light of a previous paper dealing with the part played by the spinal ligaments in the maintenance of stability and weight-bearing. Traction and Fusion-with-internal splinting therapies are analysed and my experience with a small series of the latter as well as a large series of 506 patients treated by traction therapy are presented for the reader's information. No statistical comparison is offered. Attention is particularly drawn to the importance of fractures of the posterior, lateral walls of the spinal canal, tension hemo-pneumothorax and hematorachis, and to the significance of the shape of the spinal arches in determining the frequency and site of fractures and dislocations and their effect on weight-bearing. The conclusion is reached that fusion may be useful in certain instances but no sooner than a year after the injury, and that in all other instances the preferable and indeed the only treatment that offers any hope of recovery and the avoidance of morbidity is traction therapy supplemented by the judicious use of laminectomies for diagnosis and treatment or both.