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24 January 2007

The History of Spinal Surgery

The first treatise on the treatment of spinal injuries dates back to around 1550 B.C., in the Egyptian writings known as the Edwin Smith papyrus. Hippocrates (460-370 BC), considered the Father of Medicine, is also considered to be the father of spinal surgery, having stated: "Look well to the spine for the cause of disease." His recommended method of treatment consisted primarily of traction and immobilization; similar treatments appear in ancient Arabic and Chinese literature as well. Early physicians avoided direct surgical intervention, which resulted in complications such as blood clotting, destruction of the muscle tissue, and paralysis. While medical knowledge continued to expand under physicians such as Galen of Pergamon (129-200 AD), who also coined the word, 'scoliosis,' Paulus of Aegineta (625-690 AD), Avicenna (980-1037 AD), Serefeddin Sabuncuoglu (15 c.), and Sir Percival Pott (17 c.), surgery on the spine did not become common practice until the early 1900's.

In 1953, Dr. Paul Harrington of Houston, Texas, began to develop what is now known as the Harrington instrumentation system. While initial results were promising, long-term follow up demonstrated poor results, and hardware failure was basically inevitable. The Harrington rods are essentially straight & rigid, which disrupts the normal curves in the spine. This led to dislodging of the hooks used to secure the rod.

A similar rod system was developed in 1976 by Dr. Eduardo Luque of Mexico City. These contoured rods attempted to avoid the high incidence of hardware failure through multiple points of fixation; however, this led to a higher rate of neurological complications. Dysesthesia - loss of the sense of touch - was seen in 1 out of every 10 patients.

Pedicle screw fixation, originally developed in 1949, has become a popular alternative to hooks and wires. Unfortunately, there is a very high risk of damage to the nerves and blood vessels, especially if the placement of the screws is inaccurate or unstable. Conventional placement of pedicle screws results in an accuracy rate of 45 to 85%.

New methods of surgical scoliosis correction are in high demand as research continues to document the poor long-term effects of rod instrumentation. Approaches such as spinal stapling, endoscopic instrumentation, and wedge osteotomies attempt to maintain spinal mobility while being as minimially-invasive as possible, but these procedures may not be ideal for every scoliosis patient.

No surgical procedure has ever demonstrated a 100% correction in every patient. Despite the best efforts of the medical community, surgery remains a last resort for people living with scoliosis. What is the reason for this? One might consider the lack of consideration for the position of the head & neck, both important functional components of the spine. Another reason could be the disregard for and damage done to the associated soft tissues - muscles, tendons, & ligaments - that are important in maintaining spinal integrity.

Although medicine continues to search for a "quick-fix" and an easy answer, the truth is scoliosis cannot be permanently corrected through external forces. Only through a thorough understanding of the biology & physics responsible for the deformation can the process be arrested and reversed. True scoliosis correction requires a comprehensive & holistic rehabilitation of the spine and all associated soft tissue components... and this requires a lot of hard work!

1 comment:

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