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Abstract. The authors have studied 193 cases of cervical injury with tetra paresis or paralysis in a similar way to a previous study completed in 19 73 (Bedbrook 1973 ) . Comparison with three other centres, Stoke Mandeville, Tokushima and South West Region has shown similarities and regional dis similarities-for example in aetiology.Only in cases with bilateral facet dislocation was reduction considered to have any effect on neurological recovery in all four geographical areas. The observations recorded strengthen the view that the result of the neurological injury is largely determined at the time of the accident.

Summary. Facilities providing a co-ordinated 'system' of care to the spinal cord injured are now more accepted as being preferable to fragmented 'non-system' facilities. Data reflecting the incidence of selected complications common to spinal cord injury were collected over a 2-year period from a system located outside the United States and from 'non-systems' within the United States. The latter was defined as care provided in community facilities prior to entry into one of 14 model United States spinal cord injury centres.All complications occurred more frequently in the American group, particularly decubitus ulcers and urinary tract infections.The data suggest that system care is preferable to non-system care in its capacity to prevent costly complications and the sooner the spinal cord injured patient is referred to a spinal cord centre capable of meeting all his needs, the less likely will he be exposed to complications that could slow the rehabilitation effort.

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