The report is as follows--"He had been a laborer in the mines, and while working was injured March 18, 1889, by a fall of top rock, and from this date to that of his admission had been under the care of a local physician without any sign of improvement. At the time of his admission he weighed but 98 pounds, his weight previous to the injury being 145. He exhibited entire loss of motion in the lower extremities, with the exception of very slight movement in the toes of the left foot; sensation was almost nil up to the hips, above which it was normal; he had complete retention of urine, with a severe cystitis. His tongue was heavily coated, the bowels constipated, and there was marked anorexia, with considerable anemia. His temperature varied from 99 degrees to 100 degrees in the morning, and from 101 degrees to 103 degrees in the evening. The time which had elapsed since the accident precluded any attempt at reduction, and his anemic condition would not warrant a more radical method.
"He was put on light, nourishing diet, iron and strychnin were given internally, and electricity was applied to the lower extremities every other day; the cystitis was treated by irrigating the bladder each day with Thiersch's solution. By August his appetite and general condition were much improved, and his weight had increased to 125 pounds, his temperature being 99degrees or less each morning, and seldom as high as 100 degrees at night. The cystitis had entirely disappeared, and he was able, with some effort, to pass his urine without the aid of a catheter. Sensation in both extremities had slightly improved, and he was able to slightly move the toes of the right foot. This being his condition, an operation was proposed as the only means of further and permanent improvement, and to this he eagerly consented, and, accordingly, on the 25th of August, the 9th dorsal vertebra was trephined.
"The cord was found to be compressed and greatly congested, but there was no evidence of laceration. The laminae and spinous processes of the 8th and 9th dorsal vertebrae were cut away, thus relieving all pressure on the cord; the wound was drained and sutured, and a plaster-of-Paris jacket applied, a hole being cut out over the wound for the purpose of changing the dressing when necessary. By September 1st union was perfect, and for the next month the patient remained in excellent condition, but without any sign of improvement as to sensation and motion. Early in October he was able to slightly move both legs, and had full control of urination; from this time on his paralysis rapidly improved; the battery was applied daily, with massage morning and evening; and in November the plaster-of-Paris jacket was removed, and he propelled himself about the ward in a rolling chair, and shortly after was able to get about slowly on crutches. He was discharged December 23d, and when I saw him six months later he walked very well and without effort; he carried a cane, but this seemed more from habit than from necessity. At present date he weighs 150 pounds, and drives a huckster wagon for a living, showing very little loss of motion in his lower extremities."Although few cases show such wonderful improvement as this one, statistics prove that the results of this operation are sometimes most advantageous. Thorburn collects statistics of 50 operations from 1814 to 1885, undertaken for relief of injuries of the spinal cord. Lloyd has compiled what is possibly the most extensive collection of cases of spinal surgery, his cases including operations for both disease and injury. White has collected 37 cases of recent date; and Chipault reports two cases, and collected 33 cases. Quite a tribute to the modern treatment by antisepsis is shown in the results of laminectomy.
Of his non-antiseptic cases Lloyd reports a mortality of 65 per cent; those surviving the operation are distributed as follows:
Cured, one; partially cured, seven; unknown, two; no improvement, five. Of those cases operated upon under modern antiseptic principles, the mortality was 50 per cent; those surviving were distributed as follows: Cured, four; partially cured, 15; no improvement, 11. The mortality in White's cases, which were all done under antiseptic precautions, was 38 per cent. Of those surviving, there were six complete recoveries, six with benefit, and 11 without marked benefit. Pyle collects 52 cases of spinal disease and injury, in which laminectomy was performed. All the cases were operated upon since 1890. Of the 52 cases there were 15 deaths (a mortality of 29.4 per cent), 26 recoveries with benefit, and five recoveries in which the ultimate result has not been observed. It must be mentioned that several of the fatal cases reported were those of cervical fracture, which is by far the most fatal variety.
Injury to the spinal cord does not necessarily cause immediate death. Mills and O'Hara, both of Philadelphia, have recorded instances of recovery after penetrating wound of the spinal marrow. Eve reports three cases of gunshot wound in which the balls lodged in the vertebral canal, two of the patients recovering. He adds some remarks on the division of the spinal cord without immediate death.
