Violent blows or bendings of the spine are likely to produce very serious injury to the Spinal Cord. Sometimes they cause an immediate paralysis of the parts below the seat of the injury, which gradually passes off, and thus resembles effects of concussion of the brain; sometimes they are followed by inflammation, which requires prompt treatment, in order to avert permanent paralysis or death. A severe blow on the back sometimes causes an extravasation of blood into the spinal canal, which, as it increases, causes compression of the cord and paralysis.

Dislocation And Fracture

Dislocation of the spine is rare except in the upper portion, (what is called a broken neck), but it occasionally does occur even in the chest and loins without any acccompanying fracture. The ill consequences of these accidents will of course be proportionate to the amount of injury inflicted on the spinal cord; and if that escape compression, the consequences may not be serious. Thus it may happen that one or more spinous processes may be broken off, or that the upper bones may be twisted round; and the last dorsal and first lumbar vertebrae have been displaced backwards, the patient recovering with permanent deformity, but nothing worse.

Softening

This is a frequent result of concussion or laceration of the spinal cord. The affected part becomes pulpy and diffluent, without, however, any traces of inflammation.

Spina Bifida

This is an affection depending on want of development of the spinous processes and laminae of some of the vertebrae, generally of the lower part of the chest or loins. The spinal membranes, deprived of their ordinary support, yield to the pressure of the fluid which they contain, (which also is secreted in unusual quantity), and bulge out, forming a fluctuating tumour in the middle line of the back. The legs are often palsied. The ordinary course of the case is, that the tumour enlarges, the skin becomes distended, inflames, and ulcerates, the fluid is discharged, the spinal membranes inflame, and the patient dies. Sometimes, however, when it happens that the skin and membranes are strong enough to support the distension, the patient may live out his threescore years and ten.

Treatment

Moderate support by properly adjusted trusses and bandages, and occasional punctures with a grooved needle when the tumour is much distended, seem to be the best established remedies. A cure is said to have been accomplished by cutting away the loose skin, and bringing the divided edges together by the twisted suture. But, unless the tumour is palpably enlarging fast, the surgeon had better leave it alone, since it cannot even be punctured without some risk.

Dr. John Wilson, Physician to the Glasgow University Lying-in Hospital, lately published a case treated by incision, with dressings of Carbolic Acid. The infant was a fortnight old, and the tumour the size of half a billiard ball, situated in the upper portion of the spine, near the shoulders.

The tumour was first moistened over with carbolized oil(l in 8), and then opened by a free longitudinal incision, about three quarters of an inch in length, under an antiseptic veil of surgeon's lint soaked in carbolized oil. Copious flow of serous fluid (cerebrospinal) slightly tinged with blood, probably from the incision. Simultaneously with the removal of the lint, a large piece of carbolized lac plaister was applied, and over this another, kept in position by adhesive plaister, one edge being left comparatively free for the escape of fluid. A soft, folded handkerchief laid over this completed the dressing. The child appears to have suffered a great deal for some days after the operation from vomiting and diarrhoea, which were subdued by proper treatment. The same kind of dressing was continued, and on October 19th (1871) the report was: "Child thriving and very lively. Strong in back and limbs. Flattened disc, representing tumour, still contracting. Small area in centre, about the size of half a sixpenny piece, still covered by thin membrane. Gap in vertebral arch is felt to be nearly, if not quite closed, as if by cartilage. Child about to be vaccinated, being nearly six months sold.

Malignant disease of the Spinal Column. When severe and continued pain in some part of the spine, with more or less derangement of the nervous functions, and perhaps some perceptible tumour, occurs in a patient affected with malignant disease, the probability is that some of the same morbid growth is deposited in or near the vertebrae.