Holdsworth's landmark review classifies spinal injuries into five mechanistic types based on the force applied. It asks which injuries are stable, which are unstable, and what neurologic prognosis can be given at 24 hours. Based on over 1000 patients with traumatic paraplegia or tetraplegia at the Sheffield Spinal Injuries Centre.
The 24-hour rule from this paper is still how you prognosticate cord injury at the bedside: any patient with complete motor and sensory loss below the lesion at 24 hours has irreparable cord damage.
When you examine a paraplegic patient and find brisk reflexes below the lesion but no motor or sensory return, do not reassure the family that reflexes are a good sign. Holdsworth showed this pattern means cord transection with isolated distal cord function.
The mechanism of injury tells you the stability before imaging does. A patient thrown from a horse with a flexion-rotation mechanism and a palpable gap between spinous processes has an unstable spine until proven otherwise — even if the X-ray looks benign.
For thoracolumbar rotational fracture-dislocations with paraplegia, a plaster bed is contraindicated. These patients require two-hourly turning to prevent pressure sores, and that requires internal fixation. The principle Holdsworth established that drove the development of modern posterior spinal instrumentation.
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Holdsworth's landmark review classifies spinal injuries into five mechanistic types based on the force applied. It asks which injuries are stable, which are unstable, and what neurologic prognosis can be given at 24 hours. Based on over 1000 patients with traumatic paraplegia or tetraplegia at the Sheffield Spinal Injuries Centre.
The 24-hour rule from this paper is still how you prognosticate cord injury at the bedside: any patient with complete motor and sensory loss below the lesion at 24 hours has irreparable cord damage.
When you examine a paraplegic patient and find brisk reflexes below the lesion but no motor or sensory return, do not reassure the family that reflexes are a good sign. Holdsworth showed this pattern means cord transection with isolated distal cord function.
The mechanism of injury tells you the stability before imaging does. A patient thrown from a horse with a flexion-rotation mechanism and a palpable gap between spinous processes has an unstable spine until proven otherwise — even if the X-ray looks benign.
For thoracolumbar rotational fracture-dislocations with paraplegia, a plaster bed is contraindicated. These patients require two-hourly turning to prevent pressure sores, and that requires internal fixation. The principle Holdsworth established that drove the development of modern posterior spinal instrumentation.