Fig. 416
Dislocation between the fifth and sixth cervical vertebræ. (Erichsen.)
Fig. 417
Dislocation of the spine forward (Bryant.)
Treatment.
—The injury having been localized, so far as deformity and careful study of its paralytic features will permit, the questions of prognosis and treatment become insistent. In the pure type of dislocation the prognosis will depend, first, upon whether reduction can be accomplished, and, secondly, upon the amount of damage suffered by the cord previous to such reduction. Every injury of the cervical spine is of most serious import because of the possible damage to the phrenic nerves. Rapidly ascending changes may terminate life in two or three days even though reduction be accomplished. The injuries to the lower part of the spinal column which produce paraplegia threaten life much less directly, but too frequently terminate fatally after the lapse of weeks or months, as the result of infections from spreading bed-sores, or infections through the urinary tract permitted by the constant necessity for and carelessness in the use of the catheter. The prognosis, then, in almost every case of these severe spinal injuries is unfavorable, at least if it be let alone ([Fig. 415]).
It becomes, then, a question of what can be done to improve the local conditions. Certain cases of cervical spinal dislocation have been reduced by forcible traction upon the head, assisted by rotation and manipulation with the hands in the direction indicated by the displacement of the patient’s head, as well as by such indications as may be secured in the pharynx. A considerable degree of traction may be necessary in this effort, and there is the possibility not only of failure but even of serious harm, and perhaps immediate death, since a fragment loosened may be made to produce promptly fatal pressure upon the cord. Such a measure, then, should be undertaken with the greatest care, and not without a complete understanding with those interested regarding its dangers ([Fig. 418]).
Fig. 418