It is generally accepted that the early clinical examination of a patient with a severe cord lesion is often inadequate to fix the extent of the injury. The most that can be said of many such cases is that there is a complete physiologic interruption of the cord. Whether the lesion is a recoverable one or permanent, and whether a partial lesion is being converted into a complete one by pressure are problems that may be solved by time, but rarely permit prompt decision. If the cord is not subjected to pressure, operation is not only futile but increases the damage to the spinal column already weakened by the injury.
In fracture dislocation of the spine, pressure on the cord may be caused by the displacement of fragments of the vertebrae or malalinement of the vertebral column at the site of displacement. Extradural or intramedullary collections of blood and edema
COLEMAN CC. DETERMINATION OF LOCAL COMPRESSION AS AN INDICATION FOR LAMINECTOMY: IN ACUTE INJURY OF THE SPINAL CORD. JAMA. 1925;85(15):1106–1110. doi:10.1001/jama.1925.02670150004002
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