Volume 1

A manual of surgical treatment / by W. Watson Cheyne and F.F. Burghard.

Date:
1912-1913
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: A manual of surgical treatment / by W. Watson Cheyne and F.F. Burghard. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    439/606 (page 411)
    the curve. The positions of the spinous processes are now noted and compared with those observed in the standing-at-ease position. In young children the bar may be dispensed witli, the child being lifted from the ground by the arms. The patient should next be made to stand erect and bend forward slowly vmtil the fingers touch the toes. The amount of rotation can then be estimated by noticing the asymmetry of the ribs. If it be desired to record this, a tracing of the contour of the posterior aspect of the ribs can be made with a pleximeter. This will enable tlie surgeon to differen- tiate between a case of lateral curvature and one of true scoliosis. In the patient shown in Fig. 141 A there was a marked difference in the level of the shoulders ; on making the child stoop down, however, the two sides of the thorax are quite symmetrical, showing that no rotation of the vertebrje was present. In Fig. 141 C is shown the condition found in a case of true scoliosis with considerable rotation of the vertebne. Cases are also seen in which there is very little curvature present, but on making the patient stoop advanced rotation is at once evident ; deformity of this kind is a symptom of bad import, as it is more difficult to rectify than the ordinary lateral curvature. PROGNOSIS.—The method of examination just described is of great importance both in prognosis and in treatment, as it shows how much fiexil)ility remains in the spine and gives a good indication of the best result that can be expected from treatment. When suspension fails to obliterate the curve entirely, we may fairly conclude that liga- mentous or even bony changes have taken place in the spinal column, and that therefore perfect restoration of the erect position is not likely to result from treatment. On the other hand, a hopeful prognosis may be given in those cases in which the spine straightens out completely, and the chances are that, with proper care and suitable treatment, the curve may be entirely obliterated. When called upon to give a definite prognosis in these cases, the surgeon must remember that a large number of the minor degrees are of a purely temporary nature, depending probably upon some defect in the general health, and that the curvature will either be arrested or cured as the muscles recover their tone. The disparity between the number of cases of slight lateral curvature coming under notice in early life and those adult cases in which the curvature amounts to actual deformity proves that something of this kind probably occurs in the majority of cases. The cases most prone to undergo spontaneous cure are those in which there are two slight equal curves rather than a single large C-shaped one, which tends to increase and to result in important rotation changes since there is no com})ensation. When the curvature is due to inequality in length of the two ex- tremities the cases are very amenable to treatment if seen within a reasonable time, and a good result can generally be obtained. The