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Clarification of the Problem of Vertebral Fractures from Convulsive Therapy: I. Incidence

Clarification of the Problem of Vertebral Fractures from Convulsive Therapy: I. Incidence Abstract REVIEW OF LITERATURE The problem of clinically significant skeletal complications resulting from convulsive therapy continues to warrant careful study. This has been amply substantiated within the past three years by the development of new muscle-relaxant drugs1 and the necessity for standards relating to medicolegal aspects.* It is our purpose in this section of our paper to review the literature relating to the incidence of such complications, with special reference to vertebral fractures. The emphasis on vertebral fractures is dictated by the wealth of material, the wide range in reported incidence, and the apparent lack of agreement in discussions relating to mechanisms of production and methods of prevention. In contrast, there are relatively few studies dealing with the incidence of other skeletal complications. Perhaps the problem here is clear cut. Dislocations and fractures (other than vertebral) are generally diagnosed with less difficulty and usually necessitate immediate treatment, and the clinical References 1. References 2 and 3. 2. References 50 and 51. 3. References 19, 25, 41, 53, and 54. 4. References 10 and 15. 5. References 19 and 22 to 25. 6. References 22, 37, and 43 to 45. 7. References 14 and 15. 8. Wilson, W. P., and Nowill, W. K.: Succinylcholine Chloride in Electroshock Therapy , A. M. A. Arch. Neurol. & Psychiat. 71:122-127, 1954. 9. Committee on Public Health Relations, New York Academy of Medicine: Electroshock Therapy , New York J. Med. 51:653-655, 1951. 10. Committee on Therapy, American Psychiatric Association: Standards for Electroshock Treatment, May, 1953. 11. Kalinowsky, L. B., and Hoch, P. H.: Shock Treatments, Psychosurgery and Other Somatic Treatments in Psychiatry , Ed. 2, New York, Grune & Stratton, Inc., 1952. 12. Carp, L.: Fractures and Dislocations by Muscular Violence, Complicating Convulsions Induced by Metrazol for Schizophrenia , Ann. Surg. 110:107-118, 1939. 13. Deshaies, G., and Pellier, S.: Les accidents de l'electrochocthérapie , Ann. méd.-psychol. 103: 303-344, 1950. 14. Cook, L. C.: Convulsion Therapy , J. Ment. Sc. 90:435-464, 1944. 15. Reed, G. E., and Dancey, T. E.: Compression Fractures of the Vertebral Bodies Following Induced and "Idiopathic" Convulsions , Canad. M. A. J. 42:38-39, 1940. 16. Polatin, P.; Friedman, M. M.; Harris, M. M., and Horwitz, W. A.: Vertebral Fractures as a Complication of Convulsions in Hypoglycemic Shock and Metrazol Therapy in Psychiatric Disorders , J. A. M. A. 115:433-436, 1940. 17. Pearson, M. M., and Ostrum, H. W.: Fractures of Spine After Metrazol Convulsive Therapy and Other Convulsive States , Am. J. Roentgenol. 44:726-731, 1940. 18. Pool, C. S., and Meschan, I.: Fractures of the Spine During Insulin Shock Therapy , A. M. A. Arch. Neurol. & Psychiat. 67:797-807, 1952. 19. Meduna, L. J., and Friedman, E.: The Convulsive-Irritative Therapy of the Psychoses: A Survey of More than 3000 Cases , J. A. M. A. 112: 501-509, 1939. 20. Palmer, H. A.: Vertebral Fractures Complicating Convulsion Therapy , Lancet 2:181-183, 1939. 21. Bennett, B. T., and Fitzpatrick, C. P.: Fractures of Spine Complicating Metrazol Therapy , J. A. M. A. 112:2240-2244, 1939. 22. Polatin, P.; Friedman, M. M.; Harris, M. M., and Horwitz, W. A.: Vertebral Fractures Produced by Metrazol-Induced Convulsions in the Treatment of Psychiatric Disorders , J. A. M. A. 112:1684-1687, 1939. 23. Rankin, J. H.: Prevention of Dislocations and Fractures in Metrazol Convulsions , Arch. Neurol. & Psychiat. 44:362-376, 1940. 24. Graves, C. C., and Pignataro, F. P.: Injuries Sustained During the Course of Metrazol Shock Therapy , Psychiat. Quart. 14:128-134, 1940. 25. Friedman, E.; Brett, A. L., and Vogt, E. C.: Compressions of Vertebral Bodies During Convulsive Therapy , New England J. Med. 222:704-710, 1940. 26. Cook, L. C., and Sands, D. E.: Spinal Injuries in Convulsion Therapy , J. Ment. Sc. 87:230-240, 1941. 27. Cheney, C. O.; Hamilton, D. M., and Heaver, W. L.: Metrazol as an Adjunct to the Treatment of Mental Disorders , Psychiat. Quart. 15:203-214, 1941. 28. Schatz, I., and Konwaler, B. E.: Spine Injuries Following Convulsions from Metrazol and from Idiopathic Epilepsy , J. Nerv. & Ment. Dis. 93:169-175, 1941. 29. Barrett, J. E.; Funkhouser, J. B., and Barker, W. A.: Spinal Injuries in Shock and Epileptic Convulsions , Am. J. Psychiat. 99:387-390, 1942. 30. Krause, G. R., and Langsam, C. L.: Fractures of Vertebrae Following Metrazol Therapy , Radiology 36:725-730, 1941.Crossref 31. Easton, N. L., and Sommers, J.: Significance of Vertebral Fractures as a Complication of Metrazol Therapy , Am. J. Psychiat. 98:538-543, 1942. 32. Easton, N. L., and Sommers, J.: Vertebral Fractures in Metrazol Therapy With and Without the Use of Curare as a Supplement , J. Nerv. & Ment. Dis. 99:256-263, 1944. 33. Androp, S.: Electric Shock Therapy in the Psychoses: Convulsive and Subconvulsive Methods , Psychiat. Quart. 15:730-749, 1941. 34. Darling, H. F.: Prevention of Fatality and Fracture During Electric Coma Therapy , J. Nerv. & Ment. Dis. 100:70-72, 1944. 35. Impastato, D. J., and Almansi, R.: The Electrofit in the Treatment of Mental Disease , J. Nerv. & Ment. Dis. 96:395-409, 1942. 36. Complications of and Contraindications to Electric Shock Therapy , Arch. Neurol. & Psychiat. 49:786-791, 1943. 37. Smith, L. H.; Hastings, D. W., and Hughes, J.: Immediate and Follow Up Results of Electroshock Therapy , Am. J. Psychiat. 100:351-354, 1943. 38. Impastato, D. H., and Almansi, R. J.: Study of Over 2000 Cases of Electrofit-Treated Patients , New York J. Med. 43:2057-2063, 1943. 39. Samuel, E.: Some Complications Arising During Electrical Convulsive Therapy , J. Ment. Sc. 89:81-84, 1943. 40. Tillotson, K. J., and Sulzbach, W.: Comparative Study and Evaluation of Electric Shock Therapy in Depressive States , Am. J. Psychiat. 101:455-459, 1945. 41. Lowinger, L., and Huddleson, J. H.: Complications in Electric Shock Therapy , Am. J. Psychiat. 102:594-598, 1946. 42. Huddleson, J. H., and Gordon, H. L.: Fractures in Electroshock Therapy as Related to Roentgenographic Spinal Findings , Mil. Surgeon 98:38-39, 1946. 43. Riggs, B. C., and Schlomer, G. M.: Hazards of Curarization Before Electroshock , Dis. Nerv. System 8:382-386, 1947. 44. Lingley, J. R., and Robbins, L. L.: Fractures Following Electroshock Therapy , Radiology 48: 124-128, 1947. 45. Impastato, D. J.; Frosch, J., and Wortis, S. B.: Reduction of Complications in Electro-Shock Therapy: The Reiter Machine, in Premier Congrès Mondial de Psychiatrie, Paris, 1950: IV. Thérapeutique Biologique, Paris, Librairie Scientifique, Hermann & Cie, 1953, pp. 163-169. 46. Neveu, P.: Report on the Discussions Which Have Taken Place in the Various Countries Before the Congress, in Premier Congrès Mondial de Psychiatrie, Paris, 1950: IV. Thérapeutique Biologique, Paris, Librairie Scientifique, Hermann & Cie, 1952, pp. 66-79. 47. Smith, L. H.; Hughes, J., and Hastings, D. W.: First Impressions of Electroshock Treatment , Pennsylvania M. J. 44:452-455, 1941. 48. Worthing, H. J., and Kalinowsky, L. B.: The Question of Vertebral Fractures in Convulsive Therapy and in Epilepsy , Am. J. Psychiat. 98:533-537, 1942. 49. Caplan, G.: Fractures of Dorsal Vertebrae in Epilepsy and Convulsion Therapy , J. Ment. Sc. 92:766-783, 1946. 50. Brailsford, J. F.: The Radiology of Bones and Joints , Ed. 4, Baltimore, The Williams & Wilkins Company, 1948. 51. Meschan, I.; Scruggs, J. B., Jr., and Calhoun, J. D.: Convulsive Fractures of the Dorsal Spine Following Electric-Shock Therapy , Radiology 54: 180-193, 1950. 52. Funkhouser, J. B., and Davis, H. W.: A Critical Survey of 50 Spinal Fractures Due to Electric Shock Treatments , J. Nerv. & Ment. Dis. 116: 131-137, 1952. 53. Wohlfahrt, S., and Silfverskiöld, W.: The Prevention of Skeletal Complications in Electroshock Therapy, in Premier Congrès Mondial de Psychiatrie, Paris, 1950: IV. Thérapeutique Biologique, Paris, Librairie Scientifique, Hermann & Cie, 1952, pp. 235-239. 54. Dewald, P. A.; Margolis, N. M., and Weiner, H. Vertebral Fractures as a Complication of Electroconvulsive Therapy , J. A. M. A. 154:981-984, 1954.Crossref 55. Sakel, M.: The Nature and Origin of Hypoglycemic Treatment of Psychoses , Am. J. Psychiat. ( (Supp.) ) 94:24-40, 1938. 56. Meduna, L. J.: Die Konvulsiontherapie der Schizophrenia , Halle, Carl Marhold, 1937. 57. Stalker, H.: Double Vertebral Compression Fracture from Convulsion Therapy , Lancet 2:1172-1173, 1938.Crossref 58. Wespi, H.: Ein Fall von spontaner Wirbelfraktur im Cardiazolanfall , Schweiz. Arch. Neurol. u. Psychiat. 42:404-406, 1938. 59. Cerletti, U., and Bini, L.: L'elettroshock , Arch. gen. neurol. psichiat. e psicoanal. 19:266-268, 1938. 60. Isard, H. J.: A Roentgen Evaluation of Vertebral Fractures Resulting from Convulsive Shock Therapy , Am. J. Roentgenol. 68:247-254, 1952. 61. Polatin, P., and Linn, L.: An Orthopedic and Neurological Follow-Up Study of Vertebral Fractures in Shock Therapy , Am. J. Psychiat. 105:825-828, 1949. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Neurology & Psychiatry American Medical Association

Clarification of the Problem of Vertebral Fractures from Convulsive Therapy: I. Incidence

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American Medical Association
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Copyright © 1955 American Medical Association. All Rights Reserved.
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0096-6886
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10.1001/archneurpsyc.1955.02330170006002
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Abstract

Abstract REVIEW OF LITERATURE The problem of clinically significant skeletal complications resulting from convulsive therapy continues to warrant careful study. This has been amply substantiated within the past three years by the development of new muscle-relaxant drugs1 and the necessity for standards relating to medicolegal aspects.* It is our purpose in this section of our paper to review the literature relating to the incidence of such complications, with special reference to vertebral fractures. The emphasis on vertebral fractures is dictated by the wealth of material, the wide range in reported incidence, and the apparent lack of agreement in discussions relating to mechanisms of production and methods of prevention. In contrast, there are relatively few studies dealing with the incidence of other skeletal complications. Perhaps the problem here is clear cut. Dislocations and fractures (other than vertebral) are generally diagnosed with less difficulty and usually necessitate immediate treatment, and the clinical References 1. References 2 and 3. 2. References 50 and 51. 3. References 19, 25, 41, 53, and 54. 4. References 10 and 15. 5. References 19 and 22 to 25. 6. References 22, 37, and 43 to 45. 7. References 14 and 15. 8. Wilson, W. P., and Nowill, W. K.: Succinylcholine Chloride in Electroshock Therapy , A. M. A. Arch. Neurol. & Psychiat. 71:122-127, 1954. 9. Committee on Public Health Relations, New York Academy of Medicine: Electroshock Therapy , New York J. Med. 51:653-655, 1951. 10. Committee on Therapy, American Psychiatric Association: Standards for Electroshock Treatment, May, 1953. 11. Kalinowsky, L. B., and Hoch, P. H.: Shock Treatments, Psychosurgery and Other Somatic Treatments in Psychiatry , Ed. 2, New York, Grune & Stratton, Inc., 1952. 12. Carp, L.: Fractures and Dislocations by Muscular Violence, Complicating Convulsions Induced by Metrazol for Schizophrenia , Ann. Surg. 110:107-118, 1939. 13. Deshaies, G., and Pellier, S.: Les accidents de l'electrochocthérapie , Ann. méd.-psychol. 103: 303-344, 1950. 14. Cook, L. C.: Convulsion Therapy , J. Ment. Sc. 90:435-464, 1944. 15. Reed, G. E., and Dancey, T. E.: Compression Fractures of the Vertebral Bodies Following Induced and "Idiopathic" Convulsions , Canad. M. A. J. 42:38-39, 1940. 16. Polatin, P.; Friedman, M. M.; Harris, M. M., and Horwitz, W. A.: Vertebral Fractures as a Complication of Convulsions in Hypoglycemic Shock and Metrazol Therapy in Psychiatric Disorders , J. A. M. A. 115:433-436, 1940. 17. Pearson, M. M., and Ostrum, H. W.: Fractures of Spine After Metrazol Convulsive Therapy and Other Convulsive States , Am. J. Roentgenol. 44:726-731, 1940. 18. Pool, C. S., and Meschan, I.: Fractures of the Spine During Insulin Shock Therapy , A. M. A. Arch. Neurol. & Psychiat. 67:797-807, 1952. 19. Meduna, L. J., and Friedman, E.: The Convulsive-Irritative Therapy of the Psychoses: A Survey of More than 3000 Cases , J. A. M. A. 112: 501-509, 1939. 20. Palmer, H. A.: Vertebral Fractures Complicating Convulsion Therapy , Lancet 2:181-183, 1939. 21. Bennett, B. T., and Fitzpatrick, C. P.: Fractures of Spine Complicating Metrazol Therapy , J. A. M. A. 112:2240-2244, 1939. 22. Polatin, P.; Friedman, M. M.; Harris, M. M., and Horwitz, W. A.: Vertebral Fractures Produced by Metrazol-Induced Convulsions in the Treatment of Psychiatric Disorders , J. A. M. A. 112:1684-1687, 1939. 23. Rankin, J. H.: Prevention of Dislocations and Fractures in Metrazol Convulsions , Arch. Neurol. & Psychiat. 44:362-376, 1940. 24. Graves, C. C., and Pignataro, F. P.: Injuries Sustained During the Course of Metrazol Shock Therapy , Psychiat. Quart. 14:128-134, 1940. 25. Friedman, E.; Brett, A. L., and Vogt, E. C.: Compressions of Vertebral Bodies During Convulsive Therapy , New England J. Med. 222:704-710, 1940. 26. Cook, L. C., and Sands, D. E.: Spinal Injuries in Convulsion Therapy , J. Ment. Sc. 87:230-240, 1941. 27. Cheney, C. O.; Hamilton, D. M., and Heaver, W. L.: Metrazol as an Adjunct to the Treatment of Mental Disorders , Psychiat. Quart. 15:203-214, 1941. 28. Schatz, I., and Konwaler, B. E.: Spine Injuries Following Convulsions from Metrazol and from Idiopathic Epilepsy , J. Nerv. & Ment. Dis. 93:169-175, 1941. 29. Barrett, J. E.; Funkhouser, J. B., and Barker, W. A.: Spinal Injuries in Shock and Epileptic Convulsions , Am. J. Psychiat. 99:387-390, 1942. 30. Krause, G. R., and Langsam, C. L.: Fractures of Vertebrae Following Metrazol Therapy , Radiology 36:725-730, 1941.Crossref 31. Easton, N. L., and Sommers, J.: Significance of Vertebral Fractures as a Complication of Metrazol Therapy , Am. J. Psychiat. 98:538-543, 1942. 32. Easton, N. L., and Sommers, J.: Vertebral Fractures in Metrazol Therapy With and Without the Use of Curare as a Supplement , J. Nerv. & Ment. Dis. 99:256-263, 1944. 33. Androp, S.: Electric Shock Therapy in the Psychoses: Convulsive and Subconvulsive Methods , Psychiat. Quart. 15:730-749, 1941. 34. Darling, H. F.: Prevention of Fatality and Fracture During Electric Coma Therapy , J. Nerv. & Ment. Dis. 100:70-72, 1944. 35. Impastato, D. J., and Almansi, R.: The Electrofit in the Treatment of Mental Disease , J. Nerv. & Ment. Dis. 96:395-409, 1942. 36. Complications of and Contraindications to Electric Shock Therapy , Arch. Neurol. & Psychiat. 49:786-791, 1943. 37. Smith, L. H.; Hastings, D. W., and Hughes, J.: Immediate and Follow Up Results of Electroshock Therapy , Am. J. Psychiat. 100:351-354, 1943. 38. Impastato, D. H., and Almansi, R. J.: Study of Over 2000 Cases of Electrofit-Treated Patients , New York J. Med. 43:2057-2063, 1943. 39. Samuel, E.: Some Complications Arising During Electrical Convulsive Therapy , J. Ment. Sc. 89:81-84, 1943. 40. Tillotson, K. J., and Sulzbach, W.: Comparative Study and Evaluation of Electric Shock Therapy in Depressive States , Am. J. Psychiat. 101:455-459, 1945. 41. Lowinger, L., and Huddleson, J. H.: Complications in Electric Shock Therapy , Am. J. Psychiat. 102:594-598, 1946. 42. Huddleson, J. H., and Gordon, H. L.: Fractures in Electroshock Therapy as Related to Roentgenographic Spinal Findings , Mil. Surgeon 98:38-39, 1946. 43. Riggs, B. C., and Schlomer, G. M.: Hazards of Curarization Before Electroshock , Dis. Nerv. System 8:382-386, 1947. 44. Lingley, J. R., and Robbins, L. L.: Fractures Following Electroshock Therapy , Radiology 48: 124-128, 1947. 45. Impastato, D. J.; Frosch, J., and Wortis, S. B.: Reduction of Complications in Electro-Shock Therapy: The Reiter Machine, in Premier Congrès Mondial de Psychiatrie, Paris, 1950: IV. Thérapeutique Biologique, Paris, Librairie Scientifique, Hermann & Cie, 1953, pp. 163-169. 46. Neveu, P.: Report on the Discussions Which Have Taken Place in the Various Countries Before the Congress, in Premier Congrès Mondial de Psychiatrie, Paris, 1950: IV. Thérapeutique Biologique, Paris, Librairie Scientifique, Hermann & Cie, 1952, pp. 66-79. 47. Smith, L. H.; Hughes, J., and Hastings, D. W.: First Impressions of Electroshock Treatment , Pennsylvania M. J. 44:452-455, 1941. 48. Worthing, H. J., and Kalinowsky, L. B.: The Question of Vertebral Fractures in Convulsive Therapy and in Epilepsy , Am. J. Psychiat. 98:533-537, 1942. 49. Caplan, G.: Fractures of Dorsal Vertebrae in Epilepsy and Convulsion Therapy , J. Ment. Sc. 92:766-783, 1946. 50. Brailsford, J. F.: The Radiology of Bones and Joints , Ed. 4, Baltimore, The Williams & Wilkins Company, 1948. 51. Meschan, I.; Scruggs, J. B., Jr., and Calhoun, J. D.: Convulsive Fractures of the Dorsal Spine Following Electric-Shock Therapy , Radiology 54: 180-193, 1950. 52. Funkhouser, J. B., and Davis, H. W.: A Critical Survey of 50 Spinal Fractures Due to Electric Shock Treatments , J. Nerv. & Ment. Dis. 116: 131-137, 1952. 53. Wohlfahrt, S., and Silfverskiöld, W.: The Prevention of Skeletal Complications in Electroshock Therapy, in Premier Congrès Mondial de Psychiatrie, Paris, 1950: IV. Thérapeutique Biologique, Paris, Librairie Scientifique, Hermann & Cie, 1952, pp. 235-239. 54. Dewald, P. A.; Margolis, N. M., and Weiner, H. Vertebral Fractures as a Complication of Electroconvulsive Therapy , J. A. M. A. 154:981-984, 1954.Crossref 55. Sakel, M.: The Nature and Origin of Hypoglycemic Treatment of Psychoses , Am. J. Psychiat. ( (Supp.) ) 94:24-40, 1938. 56. Meduna, L. J.: Die Konvulsiontherapie der Schizophrenia , Halle, Carl Marhold, 1937. 57. Stalker, H.: Double Vertebral Compression Fracture from Convulsion Therapy , Lancet 2:1172-1173, 1938.Crossref 58. Wespi, H.: Ein Fall von spontaner Wirbelfraktur im Cardiazolanfall , Schweiz. Arch. Neurol. u. Psychiat. 42:404-406, 1938. 59. Cerletti, U., and Bini, L.: L'elettroshock , Arch. gen. neurol. psichiat. e psicoanal. 19:266-268, 1938. 60. Isard, H. J.: A Roentgen Evaluation of Vertebral Fractures Resulting from Convulsive Shock Therapy , Am. J. Roentgenol. 68:247-254, 1952. 61. Polatin, P., and Linn, L.: An Orthopedic and Neurological Follow-Up Study of Vertebral Fractures in Shock Therapy , Am. J. Psychiat. 105:825-828, 1949.

Journal

A.M.A. Archives of Neurology & PsychiatryAmerican Medical Association

Published: Nov 1, 1955

References