1. There is no more operative risk, as shown by the immediate and late postoperative results in the above series, with the use of the beef bone splint than with any other spinal operation. In fact, theoretically, at least, there is somewhat less risk as there is only one incision and there is not as much denuding of the periosteum.
2. The results of this series show that splints made of beef rib when put into the spinous processes are tolerated by the body at least as long as four and one-half years with no sign of irritation or inflammation and only slight signs of absorption.
3. There are certain advantages in using the beef bone splint:
a. The saving of time at operation by having the bone splint prepared beforehand.
b. The saving of an extra incision such as is necessary in the use of an autogenous graft.
c. The lack of pain which may be caused by a second bone operation.
d. The possibility of preparing the bone splint before the operation for careful, accurate fitting even when the kyphos is very sharp.
e. The strength of the splint is great and can be determined by its width.
f. The possibility of getting a very long splint.
4. There are certain disadvantages in the use of the beef bone splint.
a. The beef bone being dead can act only as a scaffold and the regeneration of bone may not be as rapid as with a living bone.
b. The fact that the dead bone is a sequestrum. The results of the above series show that if it is a sequestrum, it is not an irritative one.
5. The results found in this series of cases and the two experiments on dogs make the writer feel that immobilization of the spine is better accomplished by fusion of the laminae and articular facets than by immobilization of the spinous processes by means of a beef bone splint, with or without the fusion of the laminae and articular facets on one side of the spinous processes.
6. Finally, that in this series of cases nearly one-half had more than one focus of tubercular infection and that six of these had two foci in the spine itself.
There has been one outstanding feature brought out by this investigation and also found by the Spine Commission last year. This is the marked lack of uniformity in the method of keeping the records. If we, as an Association, ever expect to be able to get any end-results which can be trusted, we must see to it that we ourselves or our house officers not only make reliable records before operation and of the operative procedure and findings, but also of the immediate postoperative conditions, and, of equal importance, accurate and intelligent notes on the subsequent conditions. We must teach our internes as well as our medical students the important points to be noted in all the above-mentioned stages so that our records will not be full of unimportant details and the important facts left unnoted. Having been working for many months on such records, I feel very strongly about this.
I would suggest that the Spine Commission make out a card which will be an improvement on the one sent out last year, so that it will be possible to have some uniformity throughout the country in the records of our spinal immobilization cases.