Pierre Franco (1505-1578): An Innovative Surgeon of the 16th Century in the Treatment of Hernia and Lithotomy.

Pierre Franco (1505-1578) was a brilliant surgeon of the Renaissance, a contemporary of Ambroise Paré. He made an impact on the history of surgery with his innovative approaches in the treatment of hernia, lithotomy, and the use of the suprapubic incision. The purpose of this study is to present a detailed account of his work, innovations, and achievements as well as the impact he made on the surgery of the Renaissance.

Spine deformities and trauma in Avicenna's Canon of Medicine.

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Avicenna (980-1037) and his contribution to the diagnosis and treatment of spinal deformities and trauma. METHOD: We conducted an extensive search in libraries as well as online in Pubmed and Google Scholar. RESULTS: Avicenna in his work Canon of Medicine combines the knowledge of ancient Greek and Roman physicians and surgeons and he combines them with the extensive of Arabic medicine and pharmacology. CONCLUSION: Avicenna made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and comments in his work Canon of Medicine summarize and comment the work of his predecessors and it remained a work of reference until at least the sixteenth century.

Abulcasis (936-1013): his work and contribution to orthopaedics.

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Abulcasis (936-1013) and his contribution to surgery and orthopaedics. METHOD: We conducted an extensive search in libraries as well as online in PubMed and Google Scholar. RESULTS: Abulcasis in his work combines the knowledge of ancient Greek and Roman physicians and surgeons with the extensive knowledge of Arabic medicine and pharmacology. He also pioneered surgical technique with the invention of numerous surgical instruments and with several revolutionary surgical techniques. CONCLUSION: Abulcasis made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and innovations in his work remained a work of reference in the West and East for many centuries to come.

Apollonius of Citium (first century BC) and his work on the treatment of joint dislocations.

The purpose of this study was to summarise the life and work of the Cypriot physician Apollonius of Citium (first century BC). His overall work on medicine is presented, and special emphasis is given to his work on the treatment of joint dislocations. The most famous work of Apollonius is Treatise On Joints, which was preserved on the whole in a manuscript of the tenth century AD. In that manuscript, Apollonius is obviously influenced by the Hippocratic Corpus of Medicine. His description, diagnostic methods and reduction techniques are all based on those described by Hippocrates in his work "On Joints". Apollonius' contribution to this subject concerns accurate depiction in images of the reduction techniques he proposes. His simplifications describe the techniques of Hippocrates in a way they can be understood and used by athletes and nonphysicians in the Greek gymnasia. Perhaps his treatise is one of the earliest works of popularised medicine and surgery in the history of human civilisation.

Injuries of the spine and of the spinal cord in the Hippocratic Corpus of medicine.

The purpose of this review article is to summarize the views presented in the Hippocratic Corpus of Medicine regarding injuries of the spine, their effect on the spinal cord and the optimal treatment modulus. It is shown that the treatment dilemmas of ancient times in these injuries remain modern since Hippocrates suggested that conservative treatment and letting nature take its course is preferable over a devastating surgical treatment if the spinal cord structural integrity is not compromised. There is also a detailed account of the conservative treatment suggested in the Hippocratic Corpus concerning devices and method of closed spinal relocations.

Alexandros Zaoussis, MD, PhD (1923-2005): An Orthopedic Surgeon and Historian and His Contribution to the Establishment of Hip Surgery.

The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopedic surgery and especially hip replacement, Alexandros Zaoussis (1923-2005). He was a pioneer in hip replacement, and he contributed to several fields of orthopedic surgery with his clinical work and his international publications. He was also an eminent historian of World War II and of the Greek Resistance to the Nazi occupation in which he played a significant part. A thorough study of texts, medical books, and reports in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. He was an eminent clinical director of orthopedics who had significant contribution in teaching, practicing, and expanding the horizons of orthopedic surgery in the 20th century. A thorough review of medical texts, books, and publications in the Greek academic press was undertaken to summarize his contributions and his turbulent life to commemorate the 10th anniversary of his death.

Currents of plate osteosynthesis in osteoporotic bone.

Osteoporotic fractures are becoming more prevalent with ageing of populations worldwide. Inadequate fixation or prolonged immobilization after non-surgical care leads to serious life-threatening events, poor functional results and lifelong disability. Thus, a stable internal fixation and rapid initiation of rehabilitation are required for faster return of function. Conventional internal fixation attempts to achieve the exact anatomy, often with extended soft-tissue stripping and compression of the periosteum, causing disturbance of the metaphyseal and comminuted fracture's bone blood supply. This technique relies on frictional forces between bone and plate. Osteoporotic bone might not be able to generate enough torque with the screw to securely fix the plate to bone. Thus, this surgical management have resulted in increased incidence of poor results in elderly, osteoporotic patients. The newly developed locked internal fixators, locking compression plates and less invasive stabilization system, consist of plate and screw systems where the screws are locked in the plate, minimizing the compressive forces exerted between plate and bone. Thus, the plate does not need to compress the bone nor requires precise anatomical contouring of a plate disturbing the periosteal blood supply. These fixators allowed the development of the minimal invasive percutaneous osteosynthesis. Nowadays, locking plates are the fixation method of choice for osteoporotic, diaphyseal or metaphyseal, severely comminuted fractures.

Congenital variations of the upper cervical spine and their importance in preoperative diagnosis. A case report and a review of the literature.

Several variations of the bony and vascular anatomy around the first and second cervical vertebrae have been reported. Failure to recognise these variations can complicate operations on the upper cervical spine. We present a patient with recent onset of cervical myelopathy due to stenosis at the C3-4 level. Preoperative evaluation identified Klippel-Feil syndrome with cervical fusion of C2-3, aplasia of posterior arch of C1, anomalous vertebral artery course and a "ponticulus posticus" of C2. The combination of these variations in a Klippel-Feil syndrome patient has never been reported. Thus, we recommend a thorough preoperative imaging evaluation, with CT scan and CT angiography or DSA, in addition to plain radiographs. This evaluation is imperative, before a cervical spine surgery, allowing a better understanding of the anatomy, in order to minimise the risks of misplacement of cervical instrumentation especially in such patients.

Lumbar synovial cysts.

Synovial spinal cysts are typically found in the lumbar spine, most often at the L4-L5 level. Magnetic resonance imaging is the diagnostic imaging of choice in the workup of suspected synovial cysts. This study consisted of 24 patients with lumbar synovial cysts treated by cyst excision and nerve root decompression through partial or complete facetectomy and primary posterolateral fusion. The most common location of the cysts was the L4-L5 segment. Synovial tissue was found in histological sections of 18 cysts. At a mean follow-up of 12 (range, 8 to 24) months, 20 patients (83%) had excellent or good results; two patients (8.3%) had fair and two patients (8.3%) had poor improvement. Operative complications included dural tear in two patients and postoperative wound dehiscence in one patient, which were treated accordingly. To eliminate the risk of recurrence synovial cyst excision through partial or complete facetectomy is required. In addition, since synovial cysts reflect disruption of the facet joint and some degree of instability, primary spinal fusion is recommended.

Finite element method in internal and hybrid external fixation of tibial condylar fractures: a comparative application study.

The treatment of tibial condylar fractures requires the preparation of personalized treatment, customized to the needs of the patient, that will take into consideration his or her personal activities. The purpose of the present study was (1) the development, by using the finite elements method, of a 3-dimensional, highly discrete, simulation model of the knee-tibia, (2) the creation of 6 types of fractures in this model according to Schatzker's classification, (3) the insertion of materials for internal and hybrid external fixation, (4) the recording of the model's biomechanical behavior during the load, and (5) the discovery of findings regarding the stability of the internal and hybrid external treatment methods. The results from the resolution procedure showed that the values of maximum displacements in every fracture type except type III were reduced in the models with internal fixation. This means decreased stiffness and therefore diminished stability of the hybrid external-bone complex in these types of fractures. Internal fixation provides postoperative stability, a basic precondition for accelerated fracture healing.

Functional outcome and complications using the intramedullary hip screw for intertrochanteric fractures.

We prospectively studied 110 consecutive patients with intertrochanteric hip fractures treated with the 130 degree angle, 10-mm short IMHS intramedullary hip screw (IMHS, Smith & Nephew, Richards, Memphis, TN). Surgery was performed within 36 hours from admission; all patients were mobilized immediately postoperatively. Fracture union, pre- and post-operative mobility status and complications were evaluated. Eighty patients were included in the postoperative evaluation for a mean followup of 14 (range, 9 to 25) months. Mortality was 19%. Union occurred in 79 fractures within 6 months from surgery; there was one case of screw cut-out and one case of deep venous thrombosis. Periprosthetic femoral shaft fractures were not observed. At the latest examination, the mean mobility score decreased from 8.4 +/- 1.6 to 7.1 +/- 2.1 (p = 0.0001); 26 patients (32%) fully achieved the preoperative mobility score and 54 patients (68%) achieved more than 90% of the preoperative mobility score. The IMHS intramedullary hip screw represents a reliable method for the treatment of patients with intertrochanteric hip fractures, and provides for early mobilization and rehabilitation of the patients with acceptable complications.

Posterior decompression and stabilization, and surgical vertebroplasty with the vertebral body stenting for metastatic vertebral and epidural cauda equina compression.

We present the technique of combined posterior decompression and spinal instrumentation, and surgical (open) vertebroplasty using a novel system called vertebral body stenting (VBS) during a single session in a patient with metastatic vertebral and epidural cauda equina compression.

Posterior transpedicular decompression for thoracolumbar burst fractures.

OBJECTIVES: To demonstrate the feasibility of spinal canal decompression through the posterior transpedicular approach in patients with thoracolumbar burst fractures. METHODS: We present 25 consecutive patients (19 men and 6 women; mean age 36 years; age range, 24-48 years) with incomplete neurological deficits (ASIA B and C) resulting from thoracolumbar burst fractures treated by posterior transpedicular spinal canal decompression and posterior segmental instrumented fusion. Canal compromise at presentation was 51.7 +/- 11.2%. RESULTS: The mean surgical time was 122 minutes (range, 108-122 minutes), and the mean blood loss was 528 +/- 123 ml. Canal compromise improved to 15.3 +/- 7.8%. At a mean followup of 14 months (range, 6-18 months), fourteen patients improved to ASIA D and were able to walk with an orthosis; seven improved to ASIA C, and four had no improvement (ASIA B). Seven ASIA B and all ASIA C patients had immediate postoperative neurological improvement to ASIA C and ASIA D; two ASIA B patients improved to ASIA C within six weeks after the operation. Anterior decompression was necessary in two (8%) ASIA B patients who did not improve after the initial operation; these patients, subsequently improved to ASIA C. There were no intraoperative complications. Superficial wound infections occurred in two patients and were treated with wound care and antibiotics; deep infection occurred in one patient and was treated with debridement and antibiotics. CONCLUSION: Posterior transpedicular spinal canal decompression and instrumentation is a reasonable alternative technique to anterior decompression procedures and circumferential fusion, providing for satisfactory canal decompression and neurological improvement.

10-year evaluation of the cementless low-contact- stress rotating-platform total knee arthroplasty.

We present the clinical and radiographic outcomes of the cementless low-contact-stress (LCS) rotating-platform total knee arthroplasty. Overall, 423 prostheses were implanted in 393 consecutive patients (30 patients had bilateral total knee replacement) for primary varus gonarthrosis (381 patients) and rheumatoid arthritis (12 patients). There were 81 men and 312 women with a mean age of 73 years (range, 58-85 years). Patella replacement was not performed in any case. Clinical and radiographic evaluation was performed using the Knee Society Score (KSS) and the Knee Society Assessment Form, respectively. The mean follow-up was 10 years (range, 5-15 years). Three patients were lost to follow-up. Survival of the prostheses was 98% at 10 years; three prostheses required revision for deep infection, bearing dislocation, and periprosthetic fracture. The mean KSS improved significantly, from 42 and 44 points preoperatively to 90 and 79 points, respectively, at the latest evaluation (P < 0.001); results were excellent in 278 cases, good in 106, fair in 27, and poor in nine. Radiolucent lines were observed in 80 cases; revision arthroplasty was not performed in any of these cases. Complications included deep infection in one patient, bearing dislocation in one, skin necrosis in four, and a supracondylar fracture in one. The cementless LCS rotating-platform total knee arthroplasty is associated with excellent mid- and long-term results for patients with osteoarthritis and rheumatoid arthritis of the knee.

Accuracy of pedicle screw placement using intraoperative neurophysiological monitoring and computed tomography.

Fifty consecutive patients with posterior thoracolumbar spine fusion were included in a prospective study to determine the accuracy of intraoperative neurophysiological monitoring (IONM) for safe pedicle screw placement using postoperative computed tomography (CT). The patients were allocated into two equal groups. Pedicle screw placement was evaluated intraoperatively by using the image intensifier. In group A, the integrity of the pedicle wall was evaluated intraoperatively with monopolar stimulation of each screw head with a hand-held single-tip stimulator; the compound muscle action potentials were recorded. A constant current threshold of 7 mA was considered indicative of pedicle breach; < 7 mA was considered as direct contact with neural elements, and > 7mA was considered normal. In group B, pedicle screw placement was performed without IONM. Overall, 306 pedicle screws were inserted in both groups. Postoperatively, all patients underwent CT scans of the spine to evaluate pedicle screw placement. Intraoperatively, five screws in respective group A patients had to be repositioned after IONM (threshold of < 7 mA); in these patients, postoperative CT scans showed proper screw placement. Postoperative CT scans showed eight misdirected screws; two screws (1.26%) in group A patients and six screws (4%) in group B patients. Two screws were misdirected through the medial pedicle wall and six screws were misdirected through the lateral pedicle wall. Both medially misdirected screws were observed in group B patients (1.35%); these patients developed neurologic symptoms postoperatively and underwent revision surgery, with redirection of the misdirected screws and subsequent resolution of the neurologic symptoms. Two of the six laterally misdirected screws were observed in group A patients (1.26%); the remaining four laterally misdirected screws were observed in group B patients (2.7%). None of these patients had neurologic sequelae; no revision surgery was required. The cut-off value of 7 mA had a 98.73% (> 95%) positive predictive value for accurate pedicle screw placement.

Paul of Aegina (625-690): His Work and His Contribution to Neurologic Surgery: Trephinations and Laminectomies in the Dark Ages.

The purpose of this historical review is to summarize the work of Paul of Aegina, especially his contribution to the treatment of neurosurgical disorders and trauma. Paul performed trephinations for head injuries in the tradition of the Egyptian and the Greek schools of medicine. However, he was an innovator in the treatment of several spine injuries, as his choice to perform laminectomies and his description of them as safe and successful is unprecedented in the history of the recorded medicine and surgery. Our search of the literature shows that Paul was the first to include in his practice such a surgical technique, and, in this way, he is an innovator, since Hippocrates described the results of spine surgery as disastrous for the patient. Thus, he may be considered the historic father of spine surgery for his pioneering surgical innovations. This shows clearly that innovation in science and medicine was significantly increased through the rise of Islam and the Arabic conquest of the Middle East. The so-called "Dark Ages" were not so dark after all.

Gerard Blaes (Blasius) (1627-1682): The Dutch Physician and Chemist, His Work and Description of the Spinal Cord.

In this historical review we summarize the work of the Dutch physician, chemist, and anatomist Gerard Blaes (Blasius). A detailed account of his life and work is presented with emphasis on his contribution to anatomy. In particular, special reference is made to his innovative description of the spinal cord and spinal nerves. Blasius's contributions to neuroanatomy are remarkable when taking into account the limited technology of his era. As a true man of his era, he made significant contributions in research and teaching of anatomy, botany, and chemistry. He published a detailed description of the spinal cord with its gray and white matter and the spinal nerve roots, which significantly increased the knowledge of neuroanatomy in his era. He also is considered one of the founders of comparative anatomy through his work in both humans and animals.

Charles Estienne (1504-1564): His Life, Work, and Contribution to Anatomy and the First Description of the Canal in the Spinal Cord.

The purpose of this historic review is to summarize the life, work, and contribution to anatomy of Charles Estienne (also known by the Latin name Carolus Stephanus). Charles Estienne was an early exponent of the science of anatomy in France. Although he remained under the influence of the Galenic tradition of medicine, anatomy, and surgery throughout his distinguished career, he had a significant influence on the scientific revolution and anatomy reformation of the 16th century. Nevertheless, he cannot be placed at the same level of contribution as Vesalius, because of his lack of discipline in his work, hesitation to diverge totally from traditional beliefs, and his hesitation for a total criticism of the Galenic tradition.

Diving injuries of the cervical spine in amateur divers.

BACKGROUND CONTEXT: Diving injuries are the cause of potentially devastating trauma, primarily affecting the cervical spine. PURPOSE: Our purpose was to describe our experience with diving injuries treatment. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: Twenty patients with diving injuries. OUTCOME MEASURES: Using the American Spinal Injury Association (ASIA) impairment scales as the primary outcome measure, the patients' neurological status before and after treatment was assessed. In this way we were able to draw conclusions about neurological improvement or deterioration in response to conservative or operative treatment. METHODS: We retrospectively reviewed 20 patients with diving injuries of the cervical spine who were admitted to our institute over a 34-year period from 1970 until 2004. RESULTS: The typical patient profile was of a young, healthy, athletic male who suffered an injury to the cervical spine after diving into shallow water. The number of cases corresponds to 2.6% of all admitted cervical spine injuries. All injures occurred between May and September. The most commonly fractured vertebrae were C5 and C6. Four patients were treated operatively and 16 conservatively. The indications for surgical treatment were posttraumatic instability and persistent neurological deficit. The mean follow-up of the patients was 17 years. Five patients died within the first month of their hospitalization and 1 patient died 1 year after his injury. Of the 14 patients who were available for follow-up 5 years past injury time, 6 improved neurologically and 8 remained unchanged in relation to their neurology upon admission. Of the 11 patients who were available for follow-up 10 years past injury time, 9 remained neurologically unchanged, 1 deteriorated, and 1 improved in relation to their neurology in the 5-year follow-up. CONCLUSION: Diving injuries of the cervical spine demonstrate high mortality and morbidity rates. Recovery depends on the severity of the initial neurological damage. Conservative treatment is justified in specific patients and can lead to improvement of the initial neurological deficit.