The Mechanism of Injury to the Spinal Cord in the Neck without Damage to the Vertebral Column

The discrepancy between damage to the spinal cord and to the vertebral column in cervical injuries has been the subject of comment by many authors. Both cord damage without vertebral column injury, and vertebral fracture and dislocation without cord dysfunction, are recognised. This communication concerns the former group. The commonly observed anatomical displacement in skeletal injuries of the cervical spine is fracture-dislocation in hyperflexion, and it is caused by hyperfiexion. Not unnaturally it was supposed that spinal cord damage without persistent vertebral displacement was caused during acute hyperfiexion, involving temporary dislocation, immediately reduced spontaneously by muscular action. This hypothetical series of events was designated ‘ ‘ recoil injury of the cervical spine. ‘ ‘ The improbability of this explanation ‘as demonstrated by Cramer and McGowan (1944). They suggested temporary intraspinal displacement of an intervertebral disc as the explanation, and postulated acute forcible flexion of the neck as the cause of the supposed temporary disc displacement. As evidence, they relied upon the occasional findings of a prolapsed cervical disc as a cause of cord compression after injury, but they did not adduce proof that a temporary prolapse can occur, nor that it could account for spinal cor