Total fracture-dislocation between the atlas and epistropheus (axis), if attended with displacement, is instantaneously fatal ([Fig. 209]). This is the osseous lesion that occurs in judicial hanging. Fracture of the odontoid process may occur, however, without displacement, the transverse ligament retaining the fragment in position and protecting the cord from injury. The patient complains of stiff neck and pain, and the lesion may be recognised in a radiogram. A number of cases are recorded in which death took place suddenly weeks or months after such an injury, from softening of the transverse ligament and displacement of the bones.

Fig. 209.—Fracture of Odontoid Process of Axis Vertebra.

Penetrating Wounds.—These result from stabs or gun-shot accidents, and are practically equivalent to compound fractures of the spine; their severity depends on the extent of the damage done to the cord, and on whether or not the wound is infected. In many cases the condition is complicated by injuries of the pleural or peritoneal cavities and their contained viscera, or by injury of the trachea, œsophagus, or large vessels and nerves of the neck. When the membranes of the cord are opened, the profuse and continued escape of cerebro-spinal fluid may prove a serious complication.

Treatment.—The wound of the soft parts is treated on the usual lines. When the spinous processes and laminæ are driven in upon the cord, they must be elevated at once by operation. In injuries involving the lumbo-sacral region it is sometimes advisable to perform laminectomy for the purpose of suturing divided nerve cords.

When there is evidence that the spinal cord is completely divided, operation is contra-indicated. Attempts have been made to unite the two ends of the divided cord by sutures, but there is as yet no authentic record of restoration of function following the operation.

CHAPTER XVII
DISEASES OF THE VERTEBRAL COLUMN AND SPINAL CORD

Tuberculous Disease of the Spine—Pott's Disease