spinal Caries. Infective Diseases of the Vertebra'. 173 



intervertebral cartilage and projecting, presses on the spinal 

 meninges and cord. It may even encircle the entire spinal cavit}' 

 and strangle the cord. If the pus should extend downward it 

 may form abscess under the spine, and rupture into an internal 

 cavity or externally. 



Symptoms. Injuries and disease of the vertebrae may last for a 

 length of time without implicating the spinal cord or nerves. 

 They may then cause only distortion, with stiffness or rigidity of 

 the spinal column. When, however, the displacement of the in- 

 jured, carious or tubercular bones, the distension of the abscess 

 or the increa.se of the hyperplasia leads to pressure on the 

 nerve roots, the meninges or cord, nervous symptoms are like- 

 ly to be developed. Compression of the nerve root.s — sen.sorj- 

 or motor — ma}' cau.se sensory or motor paralj'sis or both, 

 limited to particular areas the outline of which will point to 

 the precise seat of the lesion. If in the recti of the head and 

 other mu.scles of the neck, it points to the anterior cervical 

 vertebrae. If in the fore limbs, it points to the po.sterior bones 

 of the neck. The implication of the diaphragm would in- 

 criminate the fourth and fifth cervical vertebrae. If in the 

 crural muscles or tho.se of the quarter and thigh, the lumbar 

 vertebrae must be looked to. The implication of the nerves of 

 the back, while impairing the functions of the intercostal and 

 abdominal muscles, produce le.ss marked symptoms than when 

 the limbs are involved. 



When the disease extends deeper so as to implicate the men- 

 inges and especially the cord, there is evidence of impairment 

 or interruption of conduction in the cord in addition to the 

 simple involving of the nerves that emerge at that point. Thus 

 serious disease or pressure on the cervical part of the cord in 

 front of the fourth vertebra will make respiration difficult or 

 impossible and .speedy asphyxia may ensue. The paralysis of 

 all parts behind the lesion is overlooked, in view of the fatal 

 nature of the paralysis of the intercostals and diaphragm. If 

 the interruption of conduction is incomplete there may be 

 spastic paralysis and hyperaesthesia in the limbs and trunk back 

 of the lesion. 



If the dorsal cord is involved so as to render conduction im- 

 perfect there will be at first imperfect control of parts posterior to 



