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11.
F.
FoRSYTH:
EXTENSION
INJURIES
OF
THE
CERVI(’AL
SI’INE
1797
References
I.
BARNES,
244,
I{oLANn:
FuRSYTtI,
3.
mtt(1 Joint
RII(;ERS,
H.
Spine
Early
(if
Surg.,
-1.
3,
F.;
in
Fusion
41-A
in the
Treatment
: 17-36,
Jan.
‘IV. A. : Treatment
of
245-258,
Apr.
1942.
A. H., an-md BLACKWOOD,
TAYLOR,
Normal
Radiographic
J.
\\IIITLEY,
Bllemmtgenol.,
E.,
83
and
Bone
and
Joint
Surg.,
H.
30-B
: 239-
produced
MACNAB,
iuead,
it seeius
time Cervical
Paraplegia
J. Bone
and
The
Spimue.
J.
Bomue
amm(1 Joimmt
in Hyperextensiotm
Cervicmd
Immjuries
Joimmt Surg., 30-B : 245-248,
May 1948.
Classification
of
of the
F.tI.C.S.*,
Cervical
Spine
Lecture,
differ
worth
The
_-lmerican
head
to
fnomm timose
while
Cervical
TORONTO,
of an accideumt,
the
on. sideways-iuijury
iumti-mis way
of the
Time Advmtmmtages
Spime.
J. Biimme
Injuries.
Am.
J.
1960.
Course
If, as a result
backwam’d,
forwamd,
F.:
of
Injuries
IAN
It. (
Cervical
UNm)ERI)AL,
1959.
WILLIAM:
FORSYTH,
.111 Instructional
Spine
ONTARIO,
Aca(le(ny
CANAI)A
of Orihopoedie
SU1’(J(OflS
accelerates
in relatiomi
the u-meek m-m-mayresult.
resulting
to differemmtiate
froni
forced
them-mm by the
to ti-me tt-uuik-----Because
lesioms
passive
m-mmovemiuents of
ten-mum acceleration
injuries
1leC1’.
accelenationi
In
the
veigimt
itijunnies,
of ti-me head
m-ma)veummemmt stops,
dim’ectly
to
(imest
applied
time force
ftmlem’utmm. \Vith
imea(i,
a
iimcnuies
of time pool
eouititmues
ti-mat
n-meek stops.
he
amd
accidemits,
au-md the
to
ti-me head
Timis fact
for
applied
to
chum as a fulcnunm
an-md eouitinuiumg
force
well as a flexion
effect
is produced,
so coim-mumionly seen after
diviumg injuries.
people
limmmits
ai-md itmjury
flexiom
spitie,
immovemmienit stops
whenm the
ti-mis m-m-movemm-meumt
is also withiu
latem-al
Wimemi
ft’omn
a
whemm ti-me iuead
blow’
of ti-me
ti-me cimiti imits ti-me
an-md ti-me cl-mimi acts
as
a
applied
to the hack of time
aceountimig
for ti-me gu-oss
as
ti-me imead
at-md, therefore,
witim healthy
explains
flexed,
time head
to
the
mnauiy of the
resulting
exaim-mple,
n-meek is acutely
equivalemit
is mmovimmg.
immjun-ies
the
tuactiomi
\Vimen
muemit
to ti-me mmeck is roughly
speed
itmj uries
mi divimg
ti-me head.
applied
the
to the
acceleratiomm
imits ti-me i)ottotim
, hunt
by
applied
ti-me force
1)etween
victitmi
ti-me force
nm-multiplied
t ime differences
pate,
J.
Injuries.
C. H.; and
of Frmrettmre-1)islocation
Appearances.
: 633-644,
BY
time
Spine
DAVIS,
Fracture-Dislocation
Acceleration
()/ I/u)
Cervid-ai
E. A.;
ALEXANDER,
Surg.,
24:
with
Parmiplegia
1948.
May
2.
is thrown
formvatd
by forward
acceleration
of time head,
mm-movethe force applied
stop wimeui the cimiti hits the chest.
In mi-most
spinmes, ti-mis raumge of tmmoven-meuit is well withium physiological
rarely
results.
acceleration
Sitniiarly
wheu
the
head
is throwm
laterally,
lateral
head
hits ti-me shoulder.
With
a healtiuy
eet’vical
physiological
liu-mmits; anmd, as omme w-ould amtici-
of ti-me imead
does
not
pn-oduee
signifieammt
dammmage to ti-me
mieck.
Iii extetmsiomm-aceelen-atioum
imiovcmiuemmt umitil
iioummmally
the
permmmitted
sigumiflcammt
\_(
1841)
lm._ 46-A,
\Iltige
NIl.
of
injuries
dam-mmage
theoretical
‘ihese
*
hits
ranmge
extemisiom-acceleration
catuse
immjunies,
occiput
Street,
11. t)t-:( ‘i-:MmER
than
the
mnovcmneumt.
1964
theme
Ommtario,
appeal
Canada.
is miotimimig to stop
chest
Ome
(so-called
wimiplash
lateral
or forward
considerations
I’or(Int(I,
however,
posterior
to
wall.
nmight
is way
amticipate,
iumjuries)
acceleration.
he
Timis
would
fri accon-d
backward
heyomid
therefore,
ti-me
ti-mat
he mnoi-e promie
witim
cliudeal
obser-
to
1798
A.A.O.S.
vatiomms.
Im-ma review
cervical
spin-me
flexiomm
of 575
the
as
iujuries
INSTRUCTIONAL
result
patients
who
of autonuobile
suffered
COURSE
significant
had
LECTURE
sustain-med
accidenmts,
disability.
Of
acceleratioum
none who
sixty-nine
injuries
of ti-me
had sustain-med
forward
patients
with
latet-al
flexion
strains,
only seven
had n-meek paini and only two had umminmordisability
which
commtiimued for mm-morethan a few weeks.
The patients
sustaining
extensiomm-acceleration
imijunies,
however,
had ni-much ui-more prolonged
syunpton-m-ms. There
wene 266 patients
with
this
type
litigatiot.
of injury
Of
havimmg
these
um-muiecessary
likely
to
such
to the
present
study)
reviewed
tomnms were
two
to
for
continued
action.
or n-more years
review
145
neurotic,
uumajority
the
of
analysis
plained
of the
purely
comimplain
thrownm
were
timime;
the
patients’
symptotus
n-majority
rather
avoid
than
bias
two
of the
further
study.
said that
patients
with
the
patients
to believe
neurosis.
manifestations,
all
mi-mon-c
patients
or ti-more after
the
settle-
residual
syump-
ti-me persisten-mce
whiplasim
inmjuries
are
of people.
Although
of continuiumg
anxiety,
a
the
ati
that their
synmiptot-mis cain be cxIf the symmiptom-mms of which
they
it
is difficult
to
unden-statmd
why
become
neurotic
if their
head
is throwtm
backwards
au-md tiot if it is
or fromn side to side. Son-me patients
sustained
conconmitaut
injuries,
wrist
or a sprained
ankle.
there was a return
to nornial
sprained
ankle
necks
also
still
becan-me
hurt.
It
resulting
In these
function
instances,
the fracture
of the
withitm the expected
period
of
asympton-matic
is difficult
from
result
of a litigation
should
still have
an
to
within
understand
the
expected
why
the
titne,
patieumts’
hut
trau-
and not be t-eflected
in eoiuat the satime timime. Moreoven,
extension-acceleration
neurosis,
symptoumis
is a rennarkable
paucity
basic underlying
lesions
resulting
spitme. It was decided,
therefore,
iujury
it is difficult
to explain
two years
or n-more after
of the
u-meek are
45 per cent of
settiemi-ment
of timeir
why
dropped
of irmforunation
in the
from extension-acceleration
to attenpt
to reproduce
literature
the
in regard
to the
inmjuries of ti-me cervical
inmjury experimentally.
platform
which
could
be
down
a vertical
runway.
The aninmal’s
head and neck projected
beyond
the
of the platfornim
so that when
it can-me to an abrupt
stop at the en-md of ti-me ruimthe muotikey’s
head and neck were hyperextended
over the edge of the platform-mm.
Aimesthetized
ti-monkeys
The force of the
drop
from-mmtwo to
reproduce
exactly
uiiethod
was used
consisteumtly.
were
were
height
Muscle
sternocleidomastoid
colli
was
strapped
supine
to a horizontal
acceleration
injury
could
be varied
by varying
the height
of
forty
feet. It is realized
that
this experimnental
tm-method does
the forces
applied
to a hun-man neck in a rear-end
collision,
but
solely
as a pilot
experimmmental
tm-method to ascertain
whether
recognizable
injuries
By varying
the
gus
an-md
are
action.
There
way,
still
tedious,
type,
disability,
so-called
symmiptoms
edges
of
were
cured
of all of their
of 266 available
for
years
if not a frankly
dishonest,
group
patients
show
at soune tin-me symptoumms
neurotic
of this
patienmts
a significanit
if the
court
121
symuptomus
to be comnpletely
of patients
(121
umeurosis should
be confined
solely
to their
necks
disability
in relation
to other
injuries
sustain-med
the
settiemenmt
poinmtless,
continuing
tiumuitmg
purely
after
personally;
seemus
with
To
some
in the
nuisance
purely
as a broken
healed
and
these
have
to
results
nm-makes it difficult
on a basis
of traumatic
should
forwards
patients
for review
patients
exaunination.
Although
a continuing
hysterical,
attendatice
for review
were assutned
this was done
45 per cent
syt-mmptorns
pronipted
It has frequently
been
matic
study
possible
Obviously
theumiselves
of court
tment
as this,
patients.
who did not attend
synmptomns.
When
such
wrist
for
it was
symumptouns.
Iii a follow-up
of the
available
patients,
injuries
to
associated
produced
as a result
of extension-acceleration
of the drop, ui-many different
types
of lesion
were
partial
with
noted
avulsion
the
ranging
in
of the
development
severity
longus
from
colli.
Any
mm-minor tears
of a retropharyngeal
THE
JOURNAL
OF
BONE
iumjuries.
produced
were
tear
the
riot
the
at-my
of
of the
ti-me
loni-
heu-mmatoumma.
AND
JOINT
SURGERY
IAN
ACCELERATION
MACNAB
IIemiic)n’t’hages
wen’e seen
INJURIES
in time mi-muscle layer
OF
of the
THE
CERVICAL
esophagus.
1791)
SPINE
This
type
of esophageal
t(I
could
well accoun-mt for the dysphagia
comummuotuly conmmplained
of by victitums of extension-acceleration
injuries.
Damnage
tuie loumgus colli was invariably
associated
with damage
to the cervical
symumpathet-
ic
mem’vc’s;
dam-miage
so
sotne
au-md time
if
metropharytugeal
there
are
of ti-me bluut’immg
vcrtei)ral
am-mci uiystagmmmus.
was
Chic
tearing
froum-m tiri
it
the
im humnaum
seetm
somume
anmterior
vertebra.
am mtem’i( )t’ cervical
immjuries
am-md vertigo
mutseles
imi eight
etiology
niever
operated
within
in timese
associated
heuuiatoumma.
on
two
daum-mage
Comparable
yean’s
of
Jut
discogmamims,
sym-miptoins
imiectiom-m
complained
little
m-esistance
simowed
leakage
was
disc
was
disc
counlci he readily
approached
i)eemm little
Seveni
adum-mitted
mumuch
as
of
the
of ti-me eight
relief
any
patienits
2.
Serious
invat’iai)ly
the
experiumienmtal
with
associated
assessiiig
time
severity
the
s,vimmptomns
stnic
tioi
of
i
of
denived
pupils,
m’am’elv leave
iiealimmg
ni-may he
do
fu’equemtly
studies.
ceu’vieai
4.
patients
ha(i
The
i)e
less
pm’eiinminary
few- patients
VOL.
46-A,
are
the
imenmatomima,
itmsufficienit
FIow’ever,
hoarseness,
8, DECEMBER
spine
if tearinmg
Moreover,
to
ui-may occasioumally
be
reviewed
in ti-mis study
injuries.
either
did
They
because
heal
niot
relatively
soft-
lesion-ms
to
i)y
a cervical
to
cou-
ti-me cemvical
perforuning
represetit
a cross
therefore,
that
it
is
at-md
disc,
disc
roetitgenographic
were a preselected
group
of severity
of symptomims
Nevertheless,
is
1mm
syumiptomns
qtniekly
thn’ough
omi toutiuue
detected
It is to be ammticipated,
“average.”
of
justify
to prodince
an-md other
occurs
sucim
dem-mmouistrable
1964
data
irt-itatiotm.
iuwestigations
enmmphasize
time need
for fuu-ther
study
with sigumificant
injuiy
can be differentiated
eau-ly.
NO.
fusions
cervical
spin-me im mumonkeys
soft structitres
of the ueck.
sympathetic
changes
the
imiterbody
of their
case.
experit-mmental
study
cliumically,
particular
attention
should
be directed
datmmage to these
structunes,
such
as dyspimagia,
au-md incot-m-mplete.
thaum
had
it i-mad been
injuries.
spastmi or cervical
iumjuu-ies of ti-me cervical
of synmiptomims.
satisfactory
antemior
settienment
clinmical and
there
injury
to
the anterior
witim so-called
whiplash
all been sent for consultatiomm
of peu’sistence
after
ti-me
wimeum time
there
frommm which
successful
extension
damnage
to
umot produce
patients
ti-mis level,
atmit-mmals-that
vertebra
before
flexion
inmjuuy
These
ehammges
diseograumi.
At
followinmg
poinmts seem to be apparent:
injuries
of the neck are mu-mon-clikely
of dammiage.
slow
had
Although
rettopharyngeal
stignmmata
the
an-md lateral
front
snuggest ive of vertel)ral-artery
3. Most
soft-tissue
to
of a continuing
fouward
tiiami
disc
who
spine.
.
iesiotms
ititerspace.
an-md i-oetitgenmograumms
space.
At operation,
imm ti-me experiunental
repon’t
of the
dye
epidural
symmiptomims
dogummatic commelusions,
I Extetmsion-acceleratiotm
tissue
the
of their
‘l’imis is a prelitniinary
of one
of the
timese
Cervical
to repro-
the reIumarkahle
fiumding was ti-me mnani-mer in which
the
from the adjacenmt
vertebral
body on blunt
dissectiomi.
was
itjuries
time iumjectioni
into
reattachmmment
conmplete
aceeleu’ationm
dye
separated
gait-med
on no
avulsed.
of the
auiteriouly
im-mipression
r#{231}
of by
to ti-me imijection
disc
to ti-me
lesions
iumjury.
(111cc the
tiuet’e
experi-
of the
t’outinme cem’vical roentgenmogratmms
did umot reveal
any localiziug
sig.
imowevem’, were of great
itmterest.
Iti all patients,
it was possible
patiemits,
of the
deafumess,
at-md separationi
witimout
explaim
spasun
lesions
ligamimenit
occurred
might
of tiumnitus,
at-md reproducible
am-md a retropharyngeal
patiemits
this
Conmcomumitauit
time
longitudiumal
This
patients
clinically.
iustances
of ti-me ui-most inmterestimmg
of
associated
m’em’e foucid
comi-mparable
of vision
ummigimt explaim
arteries
imiemits
Imemnatomna
ami ammterior
section
of all
in that they
or because
ti-me u-esults
believed
imi order
that
would
these
ti-mat the
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