A case of paraplegia in which the second cervical vertebra was removed: With a note of the patient's condition seventeen years later

✍ Scribed by J. Hogarth Pringle

• Publisher: John Wiley and Sons
• Year: 1920
• Tongue: English
• Weight: 271 KB
• Volume: 8
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800083217

✦ Synopsis

4 scaoor,noY, age 14, who had been admitted to the Medical HOLISC of the Glasgow Royal Infirmary under the care of the late Dr. .John Lindsay Steven on May 6, 1903, was transferred to niy ward on the following day, as his condition was very urgent. He was suffering from almost complete paraplegia : the paralysis was complete in both his uppcr limbs and in the right lower limb, but not absolute in the left lower extrcmity.

The history given was that he had suffered from enlarged glands in the upper part of his neck two years prior to this, a t which time he also complained of severe pains in t,he head. Ten months ago it was noticed that he had slight difficulty in moving his left ripper limb, and that in walking his left foot, dragged. At thc end of two months this had cleared up, and' the patient was apparently we11 until the onset of his present illness, five weeks before admission. At that time i t was noticed that his right lower limb began t,o drag.

Three weeks before admission he had apparently lost all power in the right lower limb, and a weel; later power began to go from the right upper extremity. This was followed by loss of power in t.he left upper limb, and then in the left lower extremity. There had bccn no pain in the head and' no vomiting since the present paralytic condition commenced. The patient lay on his back, his hcad fixed ; the slightest attempt a t movement of his head caused intense pain in the back of the ndck. He was unable to move either of his npper limbs or his right lower extremity. Feeblc movements of flexion and extension could be made in .his left lower extremity a t the hip-and knee-joints. , Both knee-jerks were present and exaggerated.

Superficial reflexes were present iJ1 both limbs, but diminished.

Triceps-jcrk was present, and exaggerated in both arms. The patient was unable to pass urinc, and required a catheter from the time he went into the medical ward. The bowels had not acted after he came into hospital, and i t was stated that he had been 'very constipated' for some clays before admission. Respiration seemed to be entirely by the diaphragm. There was a pressure-sore over the occiput, and a fluctuating swclling extended from below this to the spine of the last cervical vertebra.

As the boy's condition was very critical an immediate operation was carried out.

An incision was made in the middle line of the neck over the whole length of the swelling, and pus evacuated. The Iaminz of the upper four cervical vertebrz were found bared of their soft parts by the pus, and those of the second, third, and fourth vertebrie were removed, and a quantity of extradural pus was evacuated from the spinal canal. The second vertebra (the axis) appeared to be completcly separated from all the surronnding soft tissues and to be entirely necrosed.

The patient stood the operation well, and .the following day he was able to raise his right upper limb off the bed, to move both his lower extremities with some freedom, to move all the fingers of his left hand, and flex and extend the left elbow ; but he could not raise the arm off thc bed. On May 9 he had a dose of castor oil, which was followed by a ~o l u n -This was attributed to a fall fourteen days previously.

Ankle-clonus was present in both limbs.

Babinslti's sign was not present.

The wound was packed with gauze.