[Dorsal medullary decompression by double approach for paraplegia due to kyphosis].
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Biomedical subjects
Publications and source records attributed to B Vlahovitch.
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Alongside classical methods used against metastatic malignant disease, two methods are suggested aimed at stabilising secondary bony lesions of the cervical spine. For the upper cervical spine an occipito-vertebral plate is used together with a bony arthrodesis using an iliac crest graft. For the lower cervical spine a mixed approach makes possible adequate medullary decompression when used in association with screw fixation of the posterior articulations using Roy Camille plates and a replacement cervical prosthesis after corporectomy.
The prognosis in serious spinal cord injury remains difficult. The neurologist has a large number of elements at his disposal, but their reliability is uncertain. Clinical information, experimental work and recent data on medullar vascularization makes it possible to isolate diagramatically in the spinal cord a medium layer which contains the pyramidal and spino-thalamic tracts. The neighbourhood of these two fasciculi confers them a similar vulnerability to severe injury. Thus when an injured tetraplegic or paraplegic patient recovers his sensitivity to pain, he finally must recover his motor function and on the contrary, the recovery of motility is impossible without a return of pain sens. Clinical observation is in consequence of major importance as it shows that the recovery of sensitivity to pain, in the case of a patient with a serious spinal cord injury, is an argument for a favourable prognosis, whereas the recovery of an isolated tact perception does not in itself makes it possible to hope for eventual recovery of motor power.
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