Fig. 215.—Thomas' Double Splint for Tuberculous disease of Spine.
If the cord is pressed upon by inflammatory products, there is muscular weakness, beginning in the arms and extending to the legs, and sometimes followed by complete paralysis. In the early stages there is retention of urine and constipation; later the bladder and rectum are paralysed, and there is incontinence.
Sudden death may result when dislocation of the atlo-axoid joint takes place.
Cervical caries has to be diagnosed from rheumatic torticollis, and from the effects of injuries, such as a sprain or twist of the spine. When a retro-pharyngeal abscess points behind the sterno-mastoid, it is apt to be mistaken for a cold abscess originating in tuberculous cervical glands. Retro-pharyngeal abscess due to other causes is described with diseases of the pharynx.
Treatment.—Extension is applied to the head, preferably by means of an elastic band fixed to the top of the bed, and the head of the bed is raised on blocks so that the weight of the body may furnish the necessary counter-extension. Lateral movements of the head are prevented by means of sand-bags. After the acute symptoms have subsided, the spine should be fixed by some rigid apparatus, such as a double Thomas' splint prolonged so as to support the occiput ([Fig. 215]).
When it is considered advisable to open a retro-pharyngeal abscess, this should be done from the side of the neck by an incision along the posterior border of the sterno-mastoid, as first recommended by John Chiene. The abscess is evacuated, and the cavity filled with iodoform emulsion, and closed without drainage. An opening made through the mouth is attended with the risks of pus being inhaled into the air-passages and of pyogenic infection.
When the patient is allowed to get up, a poroplastic collar and jacket of the Minerva type which supports the head and controls the movement of the cervical and thoracic vertebræ must be worn until the cure is complete.
