Skull Traction and Cervical Cord Injury : A New Approach to Improved Rehabilitation

In this book on the optimal treatment of the injured spinal cord we present the reasons why we consider it necessary to handle trauma­ tized medullary tissue in accordance with the classical biological principles of wound healing in general, namely by long-term, ten­ sion-free immobilization of the spinal cord. Today, such immobili­ zation for this purpose can only be achieved by surgical secure­ ment of slight dorsiflexion of the cervical spine. Traumatically compressed medullary tissue is invariably attenu­ ated and weakened. On application of skull traction, the weakened section of the compressed cervical cord is the part that is most overstretched. This inevitably results in increased neurological def­ icit. On scrutiny of the clinical records of 100 tetraplegic patients treated by skull traction at the National Spinal Injuries Centre at the Stoke Mandeville Hospital, Aylesbury, England, from 1971 to 1982, we found that therapeutic skull traction had been followed by an immediate increase in neurological deficit in 12% of the patients - a relatively high figure for the type of case in which beneficial effects oftraction were habitually anticipated. Moreover, in studies on cadavers, artificial defects in fresh human cervical cord in situ showed typical deformation following application of traction, confirming the basic deleterious effects of therapeutic skull traction on the injured cervical cord. This book is about surgical treatment of the sequelae of compressive spinal cord injury. It describes the deforming effects of this trauma on spinal cord tissue, especially on axially oriented nerve fibres, and shows how the intramedullary stress involved leads to overstretching or rupture of these fibres and consequent neurological deficit. The author proves that skull traction is similarly harmful and should therefore be excluded from therapy. Instead, he offers a new surgical method, cervicolordodesis (CLD), which exploits the biomechanical relaxation of elastically stretched medullary tissue in an approach designed to restore conductivity to damaged but surviving nerve fibres. An essential part of this book is the description of the operative CLD technique, which keeps the cervical spine in permanent slight dorsiflexion, relaxing the spinal cord enough to slacken overstretched nerve fibres and allow them the chance to heal. This exciting new approach has applications in, for example, overcoming neurological deficit in quadriplegic patients with only partial destruction of the spinal cord; its potential is highlighted by reports of significant neurological improvement in patients treated to date. This fundamental advance in the treatment of spinal cord injury heralds a new era of modern rehabilitation surgery in which CLD should become the instrument of choice in the hands of orthopaedic, general and neurosurgeons Front Matter....Pages I-XIII Front Matter....Pages 1-1 Compressive Cervical Cord Injury and Therapeutic Skull Traction....Pages 3-16 Mechanics and Biomechanics of Pons-Spinal Cord Section of Central Nervous System....Pages 17-23 Deleterious Effects of Therapeutic Skull Traction: A Retrospective Study....Pages 24-37 Cord Incision Model for Visualization of Adverse Effects of Skull Traction and Ventroflexion of Cervical Spine....Pages 38-46 Future Treatment of Cervical Spine Injuries....Pages 47-51 Summary of Part I....Pages 52-56 Front Matter....Pages 57-57 Surgical Procedure for Cervicolordodesis....Pages 59-71 Therapeutic Breadth of Surgically Secured Spinal Cord Relaxation....Pages 72-74 Summary of Part II....Pages 75-81 References....Pages 82-84 Describes the operative technique, cervicolordodesis (CLD), an advance in methods of rehabilitation surgery. The deforming effects of compressive spinal cord injury, especially on axially oriented nerve fibers, proves that skull traction is similarly harmful. CLD is designed to restore conductivity to damaged but surviving nerve fibers