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44 NORTH CAROLINA MEDICAL JOURNAL February, 1944 r fC,«E LUMBAR Fig. 1 (1) A fall, the injured person having landed upon the feet, buttocks, head, neck or shoulders. A man recently seen by us had fallen about ten feet, landed on his feet and been suddenly thrown forward. X-rays revealed comminuted fractures of both ossa calcis and an anterior crushing of the first lumbar vertebra. (2) Auto accidents that cause the occupant to be thrown suddenly forward, acutely flexing the spine. (3) A dive into shallow water, the patient striking his head or neck on bottom. (4) A blow or heavy object falling on the head, neck, or shoulders when the spine is flexed. Some surgeons state that when one of the above four histories is given routine anterior-posterior and lateral x-rays should be made in every case. Injuries to the spine so often result that the burden of proof that a fracture is not present rests with the doctor(3). Diagnosis The diagnosis is made from the history, physical examination and x-rays. When the cord is injured, there is both motor and sensory paralysis, partial or complete, below the level of the lesion. When the cord is severed or completely crushed, the reflexes are absent and the muscles powerless. If the lesion is partial the reflexes may be hyperactive and the muscles spastic. Obstruction in the spinal canal can be proven or ruled out by the Queckenstedt 3. Scudder. C. L.: The Treatment of Fractures, ed. 11, Philadelphia. W. B. Saunders. 1988. Fig. 2 test. This test consists in compressing the jugular veins lightly and noting the effect on the intraspinal fluid pressure as shown by the flow through the spinal puncture needle or a spinal manometer. In a normal individual the pressure rises when this test is made and falls promptly on release of the vein. In the presence of an obstruction in the subarachnoid space above the spinal puncture needle, compression of the jugular veins has no effect on the fluid pressure. If obstruction is found to be present, the patient should be referred to a neurosurgeon, who in most cases will resort to a laminectomy. Vasomotor failure with elevated superficial temperature and with priapism (or almost permanent erection) sometimes occurs when the lesion is above the first lumbar vertebra. Urinary complications of every type may occur, pyelitis and cystitis being the most common. Infection of this system often ends in death. X-ray is the greatest aid to diagnosis, and two views should always be made. The anterior-posterior view rarely ever shows a crushed vertebra plainly. It is the lateral view that is important. Spondylolisthesis is a condition often demonstrated by lateral x-rays of the lower lumbar region showing the fifth lumbar vertebra to be displaced anteriorly over the first sacral segment. This condition gives rise to many back ailments; it is congenital but is aggravated at times by trivial injuries, and should always be looked for (fig. 2). In x-ray examinations of the cervical spine or neck, the lateral view should be taken at First SACRAL segment ISTHESIS flFTH LUMBAP VERTEBRA OVER-RIDING-FIRST SACRAL SEGMENT
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1944 |
Identifier | NCHH-17-005 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 5 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-005.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-005 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 44 (images) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1944 |
Identifier | NCHH-17-005-0052 |
Form General | Periodicals |
Page Type | all; all images; x-ray; all images; illustration; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed51944medi_0052.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 5 |
Issue Number | 2 |
Page Number | 44 |
Health Discipline | Medicine |
Full Text | 44 NORTH CAROLINA MEDICAL JOURNAL February, 1944 r fC,«E LUMBAR Fig. 1 (1) A fall, the injured person having landed upon the feet, buttocks, head, neck or shoulders. A man recently seen by us had fallen about ten feet, landed on his feet and been suddenly thrown forward. X-rays revealed comminuted fractures of both ossa calcis and an anterior crushing of the first lumbar vertebra. (2) Auto accidents that cause the occupant to be thrown suddenly forward, acutely flexing the spine. (3) A dive into shallow water, the patient striking his head or neck on bottom. (4) A blow or heavy object falling on the head, neck, or shoulders when the spine is flexed. Some surgeons state that when one of the above four histories is given routine anterior-posterior and lateral x-rays should be made in every case. Injuries to the spine so often result that the burden of proof that a fracture is not present rests with the doctor(3). Diagnosis The diagnosis is made from the history, physical examination and x-rays. When the cord is injured, there is both motor and sensory paralysis, partial or complete, below the level of the lesion. When the cord is severed or completely crushed, the reflexes are absent and the muscles powerless. If the lesion is partial the reflexes may be hyperactive and the muscles spastic. Obstruction in the spinal canal can be proven or ruled out by the Queckenstedt 3. Scudder. C. L.: The Treatment of Fractures, ed. 11, Philadelphia. W. B. Saunders. 1988. Fig. 2 test. This test consists in compressing the jugular veins lightly and noting the effect on the intraspinal fluid pressure as shown by the flow through the spinal puncture needle or a spinal manometer. In a normal individual the pressure rises when this test is made and falls promptly on release of the vein. In the presence of an obstruction in the subarachnoid space above the spinal puncture needle, compression of the jugular veins has no effect on the fluid pressure. If obstruction is found to be present, the patient should be referred to a neurosurgeon, who in most cases will resort to a laminectomy. Vasomotor failure with elevated superficial temperature and with priapism (or almost permanent erection) sometimes occurs when the lesion is above the first lumbar vertebra. Urinary complications of every type may occur, pyelitis and cystitis being the most common. Infection of this system often ends in death. X-ray is the greatest aid to diagnosis, and two views should always be made. The anterior-posterior view rarely ever shows a crushed vertebra plainly. It is the lateral view that is important. Spondylolisthesis is a condition often demonstrated by lateral x-rays of the lower lumbar region showing the fifth lumbar vertebra to be displaced anteriorly over the first sacral segment. This condition gives rise to many back ailments; it is congenital but is aggravated at times by trivial injuries, and should always be looked for (fig. 2). In x-ray examinations of the cervical spine or neck, the lateral view should be taken at First SACRAL segment ISTHESIS flFTH LUMBAP VERTEBRA OVER-RIDING-FIRST SACRAL SEGMENT |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-005.pdf |
Document Sort | all; nchh-17 |
Article Title | What The Practitioner Should Know About Spine Injuries |
Article Author | M. A. Pittman |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-005 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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