Tubercular conditions of the spine requiring surgical and mechanical relief / by De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1905
Catalogue details

Licence: In copyright

Credit: Tubercular conditions of the spine requiring surgical and mechanical relief / by De Forest Willard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    3. Gradual Correction of the Deformity.—Forcible hand pressure upon the kyphosis at varying periods or by using the hump as a fulcrum and bringing to bear upon it the weight of the body above and below the disease, is a much safer pro- cess than immediate fracture. The advantages gained by such straightening must be immediately fixed by the application of a plaster-of-Paris cast. By this method a small amount of gain is secured, but all that is justifiable or to be expected safely. It is undoubtedly true that a large proportion of so-called straightening of the spine is due not to actual improvement of the kyphosis, but to the alteration of the curves in other portions of the column. In forced lordosis, bringing the weight of the body upon the posterior region rather than upon the vertebral bodies, is probably a large element in the benefit secured. This is true whether suspension is used or whether the dorsal fulcrum is applied directly to the kyphosis. The recumbent position upon a curved frame and extension in bed with a pad under the kyphosis during the acute stage is the best method of preventing deformity; then fixation for a long period of time by some form of splint adapted to each pax- ticular region of the spine, that is, in the cervical region the head should be thoroughly splinted, not by suspension or by a jury-mast, but by prolongation of the steel uprights so as to hold the head firmly in position with rigid splints. In the upper dorsal the same method is necessary; in the lower dorsal or lumbar either a steel or leather or similar jacket may be employed. Success depends upon the careful and long con- tinuance of retention appliance for a sufficient length of time to produce a strong bony bridge. With the screw elevation shown in Fig. i, the kyphosis and the spinal column are forced into hyperextension while the gypsum is applied. The plate over the hump is protected by a large, loose, felt cloth pad, which remains. Before the plaster fully hardens, a slit is made over the plate, which latter is so hinged that it can be with- drawn through a small opening. This opening can be closed at once by patching with plaster. A muslin suspension sling answers a similar purpose (Fig. 2).