, 1966). The incidence of such complications being rare, between 1 and 1-5 % (Martin and Maury, 1964;Barnett et al., 1966), we believe it interesting to report a similar case in order to describe in detail the nosological aspects of this affection. Of Twelve months after the beginning of the paraplegia, the following was observed: the triceps reflex in the left arm had disappeared; there had been a rise in the level of the thermo-analgesia on the left side which had passed from D6 to D2, while a lack of feeling was evident in the left upper extremity; this was also of the syringomyelic type without motor deficit. The patient then revealed that for about two weeks he had had in the swimming-pool no appreciation of warmth in his left hand.Air myelography (31 May 1966) (Dr. J. Berney) by the suboccipital and lumbar routes showed considerable widening of the cervical cord from C3 to C7, revealing in addition a fracture of the spinous process of C7 that was confirmed later by histological examination (Figs. la and b).A laminectomy of C2 to C7 (10 May 1966) (Professor A. Werner) revealed diminution of the thickness of the laminae of C3, C4, and C5 and a distended dural sac without pulsation. The swollen spinal cord showed flattening of the roots along its sides; a cord torsion brought the emergence of the left posterior roots almost to the median line. The lateral columns showed a bluish colour in places and covered a cavity which extended from C3 to C7. Puncture caused shrinking of the cord and yielded 2-3 ml of clear yellowish liquid which did not coagulate. An incision over the dorsal median septum, at the height of C5, made possible a penetration into the cavity. A little fragment of gutta percha was inserted in the incision to prevent it from closing (Dr. J. Berney). Tables 1 and 2 and Figs. 2-6 illustrate the evolution of reflexes and of the sensory and muscle deficit before and after the operation. DISCUSSION SYMPTOMATOLOGY One of the first signs which often precede the appearance of the syringomyelic syndrome is pain-abdominal, thoracic, cervical, or at the level of the arms (Schott et al., 1962;Barnett et al., 1966).In our case, we noted that one month before being aware of the thermanaesthesia in his left hand, our patient had complained of dorsal pains which were initially attributed to the muscular efforts of the motor re-education; they disappeared with massage in a few days but were followed two months later by neck pains. Moreover, palpation of the spinous process of C7 and DI was painful. It is interesting to note that these pains disappeared after air myelography.This painful symptomatology is accompanied by an ascending loss of sensation for temperature and pain which little by little reaches the cervical segments, sometimes even involving the trigeminal nucleus (Martin and Maury, 1964;Barnett et al., 1966). Accompanying or following the thermoanalgesia, by order of frequence and decreasing lesional importance, it seems that muscle power is first affected and then light touch and deep sensation. A...
