Surgical Aspects of the Treatment of Traumatic Paraplegia

In the treatment of vertebral injuries with spinal cord involvement the views expressed in recent years by surgeons, some of whom advocate exploratory laminectomv whereas others favour conservative treatment, are no less controversial than they were in the time of Astley Cooper and Charles Bell, one hundred and twenty-five years ago. Even among those who advocate surgical intervention the best time for laminectomy is still a matter of some disagreement, and this applies both to earls- and late operations. In assessing the indications for surgical intervention it is essential first to make a clear distinction between traumatic paraplegia due to closed spinal injuries anti paraplegia due to compound spinal injuries such as stab wounds and, J)articularly, gunshot and shell wounds. Moreover, the term ‘ ‘ early treatment ‘ ‘ must be defined more clearly than has been done in the past. It has been interpreted differently by various authors. Some, when they refer to ‘ ‘ early laminectomy, ‘ ‘ mean exploration within forty-eight hours of injury, whereas others believe that operation after one to two weeks is still ‘ ‘ early. ‘ ‘ A distinction should be made between surgical intervention at the most acute stage, within the first three days, and operation during the next two to three weeks. Surgical intervention within the first three days may