A stretcher that facilitates the radiographic evaluation and closed reduction of spinal fractures.

A rigid and exceptionally radiolucent stretcher with an attachment for cervical traction has been constructed. A patient is able to remain on this stretcher in the same position during the entire radiographic examination of a spinal fracture, including plain x-ray and computed tomographic and myelographic studies. Two advantages are obtained if this stretcher is used: 1) A patient's spine is well supported and does not need to be moved at any time during these radiographic studies, and 2) the application of traction during the myelography or closed reduction of a cervical fracture is facilitated.

The radiographic description of thoracolumbar fractures.

The X-ray films of 40 patients with thoracolumbar fractures were studied in order to classify the fractures, to investigate the causes of neural compression, and to define which fractures were unstable. Each fracture could be classified as a wedge fracture, a burst fracture, or a fracture-dislocation. The fragment of bone that produced neural compression in wedge and burst fractures almost always arose from the upper half of the vertebral body and had a characteristic triangular shape, as viewed on lateral x-ray films of the spine. Based on radiographic evidence, fracture-dislocations, severe burst fractures, and wedge fractures associated with marked subluxation, traumatic spondylolisthesis, or horizontal fractures of a pedicle were considered to be unstable. Mild burst fractures and most wedge fractures were considered to be stable.

The demonstration and significance of neural compression after spinal injury.

Standard metrizamide myeLography and CT myelography can accurately and safely define neural compression after a spinal injury. A lateral C1-C2 spinal puncture and a radiolucent fracture board reduce movement of the spine, and by injecting metrizamide in an isotonic concentration and by limiting the amount of contrast above a block, the risk of seizure is minimized. This capability for directly determining neural compression has important implications for the treatment of spinal fractures, and the significance of persisting posttraumatic neural compression is discussed. We believe neural compression should be the primary indication for surgical decompression after spinal injury and that evaluation for it should now be a standard part of the examination of patients with spinal fractures with potential for neurological recovery.

The treatment of malignancy of a vertebral body.

Five cases with collapse of a vertebral body due to malignancy were surgically treated. A posterior exposure was adequate for removal of the tumor within the vertebral body; and stabilization of the spine appears to have been achieved satisfactorily with Harrington rods. The indications for surgical treatment and the results are discussed. In selected cases, this procedure has been worthwhile. It has relieved pain, restored ambulation, and allowed a normal existence for patients who otherwise would have been bedridden.