Fracture-dislocations of the cervical spine.

For centuries spinal injuries, and in particular those involving the cervical region, have been feared more than any others by the layman because they are so often associated with paralysis and death. A clinical description was recorded in the Edwin Smith papyrus (Power 1934) by a medical author who wrote in 2500 B.C. : “ One having a crushed vertebra of his neck he is unconscious of his two arms and legs and he is speechless-an ailment not to be treated.” This gloomy first reference is quoted many times in a vast literature on fracture-dislocation of the cervical spine, a condition that still presents many difficulties in its treatment. The early methods were primitive, the patient being tied upside down to a ladder which was violently shaken, the presumption being that any dislocation might be reduced by this means. Hippocrates later used a more rational form of treatment and applied traction to the neck of the recumbent patient, but these cases were seldom treated successfully until the beginning of this century. Eastwood (1940) pointed out that the cervical spine may be divided clinically into two distinct areas, the first two vertebrae and the last five. Since the first two vertebrae have a different shape from the remainder, the movement taking place between them is different from that in the lower segments. Rotational movement is the primary function of the atlas and axis, three-quarters of the total rotation of the cervical spine taking place between them. The purpose of this paper is to report seventy-five injuries of the cervical spine treated in the orthopaedic service at Exeter during the years 1946-1955. Sixty-three of the cases involved the lower cervical vertebrae, and the importance of early operative treatment is emphasised in all dislocations of this region. Injuries of the atlas and axis have been extensively reviewed recently by Grogono (1954) and a description here would be superfluous.