Spinal Caries 



209 



with stiffness of the region affected. In trying to stoop the patient 

 cannot bend his neck or back, and he stands with his hands on his 

 thighs or resting against a table or chair. 



Normal curves. 



Early lumbar caries ; normal Advanced dorsi-lumbar carit 

 curves effaced. angular curvature. 



If the advance of the angular curvature be slow, the cord adapts 

 itself, and no pressure-effects are manifested. But if it come on rapidly, 

 or, coming on slowly, be extreme, motor paralysis results, because of a 

 projection taking place at the back of the bodies into the vertebral canal, 

 and impinging against the front, the motor area, of the cord (p. 215). 

 But, although a child may have complete muscular paralysis in his 

 lower extremities for many months, he may at last completely recover 

 movement ; the explanation being that much of the pressure has been 

 of the nature of inflammatory deposits, rather than of the bony pro- 

 jection. In the paraplegic child with angular curvature there is no 

 pressure upon the posterior aspect of the cord, so there is no loss of 

 sensation, and, the skin being well supplied, there is no special likeli- 

 hood of the occurrence of bed-sores, as obtains after fracture of the 

 spine. 



With pressure upon the front of the cord, the knee and ankle 

 reflexes are exaggerated because the cerebral influence can no longer 

 descend to control them (p. 220). But if the pressure be upon the lumbar 

 enlargement, as may happen in caries of the lowest dorsal vertebrae, 

 there may be so much disturbance within the cord that the afferent 

 influence can no longer awaken the motor impulse, in which case the 

 knee-jerk and ankle clonus may be lost. 



In the progress of caries, inflammatory thickenings press upon the 

 spinal nerves, causing characteristic peripheral pains in the area of 

 their distribution. When the disease is in the cervical region there may 



p 



