Case of fracture of the spine, in which the operation of trephining was performed : with observations / by Robert M'Donnell.

  • McDonnell, Robert, 1828-1889.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Case of fracture of the spine, in which the operation of trephining was performed : with observations / by Robert M'Donnell. 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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    corresponding to where the bone was displaced; Fig. 1. and when the finger was passed along it gently it felt as if softened at this inden- tion, but there was neither red nor white softening of its struc- ture, and this feeling was merely the result of pressure, which had not given rise to structural dis- organization. The body of the first lumbar vertebra was fractured, and this vertebra was displaced back- wards; the line of fracture se- parated only a small portion of the body of the broken vertebra. The intervertebral substance between the last dorsal and first lumbar vertebras had been torn, and the body of the first lumbar was displaced backwards, as shown in the accompanying woodcut. A small blood-clot occupied the space above the pro- jecting body of this vertebra, lying between the body of last dorsal vertebra and the anterior aspect of the dura mater of the cord. The spinal cord was, therefore, pushed backwards by this effused blood, as well as the body of first lumbar vertebra, not simply by the sharp ridge of bone, as might be at first supposed from looking at the woodcut. Fig. 1 represents a vertical section of the inferior part of the spinal column, as seen in the case of Collins (the lumbar vertebrae and the three last dorsal) : a, the spinous processes of the last four lumbar vertebrae; 6, the small portion broken off from the body of first lumbar vertebra; c, portions of the last three ribs. As the cord was pushed backwards, not only by the projecting body of first lumbar vertebra, but by the blood-clot filling the hollow above this projection, it is obvious that the complete removal of the posterior arches of both the last dorsal and first lumbar vertebrae would have set the cord free from pressure.