Holdsworth set out to classify spinal injuries by the type of violence that caused them and to link each pattern to stability, neurological prognosis and treatment.
Review prepared from two 1969 lectures, based on more than 1000 Sheffield Spinal Injuries Centre patients with paraplegia or tetraplegia from trauma, plus many spinal fractures without neural damage.
Methods
Design
Review article based on a personal clinical series
Patients
More than 1000 with paraplegia or tetraplegia from trauma
Many more spinal fractures without neural injury
Basis
Mechanism of injury
Clinical and radiographic findings
Key Findings
Holdsworth held that stability after spinal injury depends on whether the posterior ligament complex is intact.
Rotational fracture‑dislocations were the most unstable spinal injuries and came with tetraplegia or paraplegia almost every time, in the cervical, thoracolumbar and lumbar spine.
Complete paraplegia lasting 24 hours meant irreparable cord damage, with no exception in over 1000 patients, although paralysis from nerve‑root damage could stay complete for weeks and still recover.
Reflexes that are present or return below the lesion without any sensory or motor return are a bad sign, because they indicate a distal cord cut off from the brain.
Every shear fracture in the series came with complete paraplegia.
Board pearl
A palpable gap between the spinous processes almost always means an unstable spine, even when the radiographs are equivocal.
Authors' conclusion
Accurate diagnosis and prognosis of the neurological lesion depend on knowledge of the anatomy of the spinal cord and nerve roots, a careful neurological examination shortly after the original injury and repeated examinations thereafter, comparison of the level of spinal injury with the level of paraplegia or tetraplegia, differentiation between paraplegia and tetraplegia of immediate and delayed onset, and the appropriate therapy of the various types and levels of lesion.
Holdsworth set out to classify spinal injuries by the type of violence that caused them and to link each pattern to stability, neurological prognosis and treatment.
Review prepared from two 1969 lectures, based on more than 1000 Sheffield Spinal Injuries Centre patients with paraplegia or tetraplegia from trauma, plus many spinal fractures without neural damage.
Methods
Design
Review article based on a personal clinical series
Patients
More than 1000 with paraplegia or tetraplegia from trauma
Many more spinal fractures without neural injury
Basis
Mechanism of injury
Clinical and radiographic findings
Key Findings
Holdsworth held that stability after spinal injury depends on whether the posterior ligament complex is intact.
Rotational fracture‑dislocations were the most unstable spinal injuries and came with tetraplegia or paraplegia almost every time, in the cervical, thoracolumbar and lumbar spine.
Complete paraplegia lasting 24 hours meant irreparable cord damage, with no exception in over 1000 patients, although paralysis from nerve‑root damage could stay complete for weeks and still recover.
Reflexes that are present or return below the lesion without any sensory or motor return are a bad sign, because they indicate a distal cord cut off from the brain.
Every shear fracture in the series came with complete paraplegia.
Board pearl
A palpable gap between the spinous processes almost always means an unstable spine, even when the radiographs are equivocal.
Authors' conclusion
Accurate diagnosis and prognosis of the neurological lesion depend on knowledge of the anatomy of the spinal cord and nerve roots, a careful neurological examination shortly after the original injury and repeated examinations thereafter, comparison of the level of spinal injury with the level of paraplegia or tetraplegia, differentiation between paraplegia and tetraplegia of immediate and delayed onset, and the appropriate therapy of the various types and levels of lesion.