Medical Media Images

History of Spine Surgery

Some of the initial written descriptions of spine care date back to what is called the ‘Edwin Smith’ Papyrus (“ancient diary), named after the explorer who discovered them.  It was authored by an ancient Egyptian surgeon by the name of Imhotep. This document describes 6 cases of spinal trauma and was able to correctly identify the injuries, which included paralysis.

The Greek physician Hippocrates (460-375 B.C.) was able to identify the anatomy and pathology (disease) of the spine in great detail. He correctly identified the disease of spinal tuberculosis as well as specific traumatic injuries to the spine. He also invented several medical devices designed to stabilize a dislocated spine.

Galen of Pergamon (130-200 A.D.) was a prominent Roman surgeon. He worked as the official surgeon for the gladiators of Rome. He was an outstanding anatomist who also identified the normal spinal curvatures (lordosis, kyphosis) and attempted to correct abnormal ones (scoliosis).

Paulus of Aegina (625-690 AD) was a Greek physician who wrote an encyclopedia consisting of 7 volumes where he summarized the spine knowledge of the previous 1000 years. He is also been given credit of performing the first spinal laminectomy (removal of the lamina bone on the back of the spine to gain access to the spinal nerves and disc). He performed the surgery on a patient with a fractured spine whose spinal cord was compressed.

Avicenna (460-375 A.D.) was a famous Persian physician who authored many medical textbooks. One of his works correctly described the biomechanics (motion of the spine) of the spine.

Abulacasis (936-1013 A.D.), an Arabian surgeon, was able to describe a number of spine diseases, such as sciatica, low back pain, and scoliosis.

In the 16th century of Europe, actual Universities were established and the spread of knowledge blossomed.

Leonardo da Vinci (1452-1519 A.D.) described spinal anatomy in even more detail than was previously known. He was able to translate some of this knowledge into spinal biomechanics (motion of the spine).

Andreas Vesalius (1514-1564 A.D.), a Belgian anatomist is considered the father of anatomy. He was able to correct some the earlier mistaken anatomical concepts. His detailed descriptions include the spinal disc and foramen (openings for nerves to leave the spine).

 

Giovanni Alfonso Borelli of Italy (1608-1679 A.D.) was able to describe the function of the human disc and its properties. He also identified the role of the spinal disc.

In the 19th century, the laminectomy (removal of spinal lamina) was widely established to treat a number of spinal conditions, including tumors, infections and trauma. The main goal of this operation was to make room for the spinal cord and spinal nerves from compression. It remained the only spinal surgery for some time. Much scientific debate existed during this time as to whether spinal surgery should even be performed. The outcomes of spinal surgery were poor. Antiseptic (sterile) techniques had not been discovered yet. Infections after surgery were commonplace. One of the few bright moments in spine surgery during this period was a surgery performed by a Kentucky surgeon, Alban G. Smith in 1828. He operated on a patient who had fallen from a horse, sustained a spine fracture and became paralyzed. Dr. Smith was able to remove the compression of the spinal cord at multiple spinal levels. The patient had a partial recovery of the spinal cord and survived the surgery. This made Dr. Smith one of the pioneers of modern spine surgery.

Following the invention of aseptic (sterile) technique, improved anesthetic techniques and more modern spinal instruments, spine surgery became more widely accepted.

While disc herniations were first recognized by Rudolph Virchow in 1857, it wasn’t until 1908 that the first disc surgery was performed by Dr.s Oppenheim and Krause. However, they did not identify the material they removed from the spine as disc material. They thought it was a benign cartilage tumor. In 1911, John Goldthwaite was the first to discover the disease of disc herniations.

In 1929 Dr. Walter E. Dandy published an article about disc herniations and sciatica. It explained how a disc herniation can cause sciatica.

The first spine surgeons to intentionally treat spinal disc herniations were Dr.s Mixter and Barr who performed the first such operation in 1932.

Spinal fusions were first described by Albee and Hibbs in 1911. The first such surgeries were performed on patients with Pott’s disease (tuberculosis of the spine). This disease process would weaken the spine over time, causing severe deformities. The spinal fusion surgery attempted to stop this process. During this time, metal began to be used in the spine to add stability to fusion surgeries performed for spine trauma. However, the metal used in this period was subject to breakdown and rusting.

Dr. Paul Harrington is credited with inventing the modern spinal stabilization system. He invented the “Harrington Rod” which is a metal rod and screw system implanted for patients with a scoliosis of the spine. His system was initially used for patients with severe scoliosis due to polio. It was later adapted for many other types of spine surgeries.

The modern era of spine surgery followed these early pioneers and can be credited with many new technological advances and surgical approaches to the spine, culminating in modern artificial disc replacements, the use of stem cell technology and minimally invasive spine surgery.