There are many classifications of injuries of the cervical spine. This is not the place to debate their merits and demerits. Suffice it to say that in this paper the classification used is broadly based on that proposed by Holdsworth (1963), and also relates to the work of Roaf (1960) and Beatson (1963), whose important experimental work increased the general understanding of the mechanisms involved. However, and this point must remain to be argued later, it is felt that these authors oversimplify flexion-rotation injuries and Stringa's (1963) subgroup of 'anterior subluxations' is included. Classification and Incidence I. Atlanto-axial injuries. 8 2. Flexion-rotation injuries 95 (a) Anterior subluxations 19 (b) Flexion-rotation dislocations and fracture-dislocations with unilateral posterior intervertebral joint dislocation 41 (c) Flexion-rotation dislocations and fracture-dislocations with bilateral posterior intervertebral joint dislocations

Abstract. Three detailed case histories are added to those previously published in the literature and from the evidence now available a proposal is made that a paediatric syndrome of traumatic myelopathy without demonstrable vertebral injury be recognised as a definite clinical entity. The mechanisms of injury, evolution, patterns of paralysis and pathological evidence are discussed. The conclusion is drawn that no form of treatment yet known can influence the prognosis in this syndrome.

THE management of a patient with acute tetraplegia is beset with many different problems. The problems may be divided into those associated with the injury to the spine and spinal cord, those associated with other common complications such as head, chest and limb injuries, and those associated with the respiratory and metabolic consequences of this type of injury. The term injury includes not only the accidental trauma but also, where necessary, subsequent operative treatment, with or without general anaesthesia. On occasions there may be days or even weeks between these components of the 'injury'. In a previous paper (Cheshire, 1964) a broad plan for respiratory assessment and management was suggested, and while the hypoventilation syndrome, the management of a tracheostomy and the effects of body temperature on the oxygen requirements of the tetraplegic patient will be discussed in this paper, its primary purpose is to present the special metabolic problems of the acute tetraplegic and to propose a regime for the coordinated treatment of respiratory and metabolic states. I Since Volume (Yrs) Lesion Accident Capacity (Months) (ml) (ml) l. (G. B.) 21 Complete below C6 3 310 2200 , 2. (B.R.) 27 Complete below C6 3 460 2000 3. (D. C.) 14 Complete below C6 4 445 2000 4. (A.M.) 19 Complete below C5 23 500 1950 5. (B. P.) 28 Complete below C5 33 530 3000 6. (B. S.) 29 Complete below C5 38 250 1500 7. (A. P) 46 Complete below C6 39 470 1550 8.

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