Injury to arthritic spine.... 6 Total... 7 234 THE JOURNAL OF BONE AND JOINT SURGERY PARAPLEGIA IN CERVICAL SPINE INJURIES

The first recorded reference to paraplegia in cervical spine injuries is to be found in the Edwin Smith papyrus, written some four thousand years ago. The unknown author corn-ments briefly upon the condition: ‘ ‘ One having a crushed vertebra of his neck, he is uncon-scious (1)f his two arms and two legs, and is speechless. An ailment not to be treated. ‘ ‘ Such pessimism was not without justification for in spite of notable contributions by Walton and Taylor, and more recently the introduction of caliper traction by Coleman, McKenzie, and Crutchfield, considerably more than half the patients with parapjjie from the of spinal cord injpy, and many survivors are left with varying degrees of paralysis. One of the most puzzling features of injuries of the cervical spine is the lack of correla-tion between the degree of vertebral displacement and the severity of the spinal cord lesion. There are cases with no radiographic evidence of bone injury in which the cord is irretrievably damaged; others, with gross dislocation, may have no paraplegia. It is commonly believed that the spinal cord is damaged by the dislocated neural arches, and in the absence of radiographic evidence of bone injury it is assumed that spontaneous reduction of th