Insights into the Past and Future of Atlantoaxial Stabilization Techniques.

Over the past century, atlantoaxial stabilization techniques have improved considerably. To our knowledge there has been a scarcity of articles published that focus specifically on the history of atlantoaxial stabilization. Examining the history of instrumentation allows us to evaluate the impact of early influences on current modern stabilization techniques. It also provides inspiration to further develop the techniques and prevents repetition of mistakes. This paper reviews the evolution of C1-C2 instrumentation techniques over time and provides insights into the future of these practices.We did an extensive literature search in PubMed, Embase and Google Scholar, using the following search terms: 'medical history', 'atlantoaxial', 'C1/C2', 'stabilization', 'instrumentation', 'fusion', 'arthrodesis', 'grafting', 'neuroimaging', 'biomechanical testing', 'anatomical considerations' and 'future'.Many different entry zones have been tested, as well as different constructs, from initial attempts with use of silk threads to use of hooks and rod-wire techniques, and handling of bone grafts, which eventually led to the development of the advanced screw-rod constructs that are currently in use. Much of this evolution is attributable to advancements in neuroimaging, a wide range of new materials available and an improvement in biomechanical understanding in relation to anatomical structures.

Spines of Steel: A Case of Surgical Enthusiasm in Cold War America.

Just as the prevalence of scoliosis began to decline precipitously after World War II, American orthopedic surgeon Dr. Paul R. Harrington devised a new, invasive surgical system whereby implantable prosthetic metal rods and hooks were used to straighten curved backs. By the 1970s, "Harrington rods" had become the gold standard of surgical scoliosis care in the United States, replacing more conventional methods of exercise, bracing, and casting. This article situates the success of Harrington rods within a much larger and historically longer debate about why, when compared to those in other nations, American surgeons appear to be "more aggressive" and "knife-happy." Using Harrington's papers and correspondence, I argue that patients played a vital role in the rise of spinal surgery. As such, this article examines not only how surgical enthusiasm has been historically measured, defined, and morally evaluated, but also how scoliosis became classified as a debility in need of surgical management.

Nicholas J. Giannestras (1908-1978): a distinguished orthopaedic surgeon, his work, life and times.

The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopaedic surgery, Nicholas J. Giannestras (1908-1978). 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. Giannestras left his mark in the history of orthopaedics with his clinical work and his publications, mainly his treatise "Foot Disorders: Medical and Surgical Management" (1973), while his name lingers in Greece with the introduction of spine fusion with the use of metallic implants. He was an eminent university clinical professor of orthopaedics who had harmonically combined academic writing, teaching and clinical research in every field of orthopaedic surgery.

[Therapy of scoliosis from a historical perspective]. / Therapie der Skoliose aus historischer Sicht.

Scoliosis can be considered as one of the classical orthopedic diseases of the spine. The history of orthopedics is closely connected to the development of the therapy of scoliosis. In the eighteenth and the beginning of the nineteenth centuries the therapy of scoliosis was mainly a conservative corrective orthopedic treatment with a variety of corset forms and extension bed treatment. In the middle of the nineteenth century physiotherapy (movement therapy) became established as an supplementary active treatment. The first operations for treatment of scoliosis were carried out in 1839. The real success with surgical procedures for improvement in corrective options was connected to the introduction of metal spinal implants in the early 1960s.

[History of vertebral body replacement]. / Geschichte des Wirbelkörperersatzes.

BACKGROUND: Vertebral body replacement after corpectomy is nowadays a standard procedure in spinal surgery. OBJECTIVE: Description of the developmental process of vertebral body replacement. METHOD: Historical description of the innovations in vertebral body replacement. RESULTS: The first serious attempts to perform vertebral body replacement were initiated approximately 50 years ago. Over several decades spinal surgeons used bone grafts, polymethyl methacrylate, titanium and glass-ceramics containing apatite and wollastonite. Known vertebral surgeons, including Scoville, Polster, Kaneda and Harms, to name but a few, were involved in the continuous development of vertebral body replacement. CONCLUSION: Many different expandable and non-expandable implants are now available and both types of implant can still be justified. This article describes the historical development of these implants and shows how this innovational process has significantly increased the therapy options for surgeons.

The Prolo Scale: history, evolution and psychometric properties.

BACKGROUND: The Prolo Scale (PS) is a widely accepted assessment tool for lumbar spinal surgery results. Nevertheless, in the literature there is a dearth of consensus about its application, interpretation and accuracy. The purpose of this review is to investigate the evolution of the PS from its introduction in 1986 to the present, including an analysis of different versions of the scale and research on the existing studies investigating its psychometric properties. MATERIALS AND METHODS: PubMed, Cochrane Library and PEDro databases were searched. Studies in English, Italian, French, Spanish and German published from 1986 to December 2012 were analyzed. RESULTS: The original lumbar surgery outcome scale consisted of two Likert-type scales (economic and functional). There are three more versions of the scale: Schnee proposed one consisting of 10 items, Brantigan made one with 20 items and introduced 2 more subscales (pain and medication), and Davis adapted the scale for the cervical spine. PS is often mentioned without any specific reference to the version used; therefore, a homogeneous comparison of studies is difficult to achieve. Several authors agree on the need to embrace a multidimensional measuring system to evaluate low back pain (LBP), but there is still no consensus regarding the most reliable tool. To date, PS has been mostly used as secondary outcome measure in association with validated primary measures for LBP. CONCLUSIONS: The Prolo Scale has been adopted for clinical examination for 20 years because it is easy to administer and useful to compare significant amounts of data from surgical studies carried out at different times. Although several authors demonstrated the scale sensitivity among a battery of tests, no thorough validation study was found in the current literature.

Cervical spine surgery: an historical perspective.

BACKGROUND: Continued innovation in surgery requires a knowledge and understanding of historical advances with a recognition of successes and failures. QUESTIONS/PURPOSES: To identify these successes and failures, we selectively reviewed historical literature on cervical spine surgery with respect to the development of (1) surgical approaches, (2) management of degenerative disc disease, and (3) methods to treat segmental instability. METHODS: We performed a nonsystematic review using the keywords "cervical spine surgery" and "history" and "instrumentation" and "fusion" in combination with "anterior approach" and "posterior approach," with no limit regarding the year of publication. Used databases were PubMed and Google Scholar. In addition, the search was extended by screening the reference list of all articles. RESULTS: Innovative surgical approaches allowed direct access to symptomatic areas of the cervical spine. Over the years, we observed a trend from posterior to anterior surgical techniques. Management of the degenerative spine has evolved from decompressive surgery alone to the direct removal of the cause of neural impingement. Internal fixation of actual or potential spinal instability and the associated instrumentation have continuously evolved to allow more reliable fusion. More recently, surgeons have developed the basis for nonfusion surgical techniques and implants. CONCLUSIONS: The most important advances appear to be (1) recognition of the need to directly address the causes of symptoms, (2) proper decompression of neural structures, and (3) more reliable fusion of unstable symptomatic segments.

Development and growth of anterior spine surgery in Minnesota.

Until the 1960s, it was not possible to directly access the thoracic vertebrae in order to correct conditions such as congenital kyphosis. Attempts to treat problems using traditional posterior spine surgeries often failed, leaving patients paraplegic. Using a procedure initially done in Hong Kong, surgeons from the University of Minnesota in 1966 became some of the first in the United States to access the thoracic spine from the anterior position, allowing for correction of deformities. This article highlights Minnesota surgeons' contributions to the development of anterior spine surgery.

The History of Anterior and Lateral Approaches to the Lumbar Spine.

Anterior and lateral approaches to the lumbar spine are commonly used today for a variety of indications. These approaches can ultimately be traced back to early attempts to treat Pott's disease. Evidence of Mycobacterium tuberculosis infection of the spine dates as far back as 2400 BCE, with ancient Egyptian mummies exhibiting lesions consistent with Pott's disease. For many centuries, Pott's disease was treated conservatively, and surgery came to be used when conservative therapy was ineffective, as medical therapy had yet to become available. In 1779, Percivall Pott recommended that peripheral paraspinal tuberculous abscesses be drained after noticing that patients' lower limb function improved after the formation of spontaneous draining sinuses. Building on Pott's ideas, Ménard described the first lateral approach to the spine via a costotransversectomy approximately 1 century after Pott's theory. Most importantly, the surge in understanding anatomy with respect to developing safe corridors to the deeper structures of the human body brought together advances in technology, instrumentation, and visualization. Surgeons were thus emboldened to explore more complex anterior approaches to the spine. In 1906, Müller reported the first successful anterior approach to the spine in a patient with Pott's disease. Over the next several decades, the efforts of surgeons such as Ito, Capener, Burns, and Mercer would lead to the development of the anterior lumbar interbody fusion. The costotransversectomy later evolved into the lateral rhachotomy and lateral extracavitary approach, which along with advances in the anterior lumbar interbody fusion paved the way for the oblique lumbar interbody fusion and lateral lumbar interbody fusion.

Right Versus Left Approach to Anterior Cervical Discectomy and Fusion: An Anatomic Versus Historic Debate.

The debate over the influence approach sidedness has on the risk of recurrent laryngeal nerve palsy (RLNP) following anterior cervical discectomy and fusion (ACDF) has its origins with the introduction of the procedure for radicular pain in the 1950s. The recurrent laryngeal nerves follow disparate courses in the lower neck secondary to differences in embryogenesis. Because of these differences, some authors believe a right-sided approach increases the risk of RLNP. However, modern surgical series have not shown a clear risk of RLNP with a right- versus left-sided approach. By looking at the historical context surrounding the introduction of ACDF, we propose the dogmatic view of an increased risk of RLNP with a right-sided approach likely arose from a combination of theoretical anatomic risk and the early surgical experience of a pioneer of the procedure.

History of cervical disc arthroplasty.

Enthusiasm for cervical disc arthroplasty is based on the premise that motion-preserving devices attenuate the progression of adjacent-segment disease (ASD) in the cervical spine. Arthrodesis, on the other hand, results in abnormal load transfer on adjacent segments, leading to the acceleration of ASD. It has taken several decades of pioneering work to produce clinically relevant devices that mimic the kinematics of the intervertebral disc. The goal of this work is to trace the origins of cervical arthroplasty technology and highlight the attributes of devices currently available in the market.

History of Integral Fixation for Anterior Lumbar Interbody Fusion (ALIF): The Hartshill Horseshoe.

OBJECTIVE: Anterior lumbar interbody fusion (ALIF) is a common spinal fusion option for different spinal pathologies. In the early years, implant migrations/expulsions were potential complications of ALIFs due to the lack of integral fixation. We present a historical vignette on the inception and development of the first stand-alone ALIF (SA-ALIF) implant-the Hartshill Horseshoe (HH). METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic search was carried out for 3 online databases focusing on implant development for ALIF, refining the search to before 1995. A personal communication with the original patent holders of the HH was used due to the lack of formal publication of the HH during its early years. RESULTS: Since 1932, the idea of anterior lumbar fusion was proposed and was carried out in 1933 using a tibial peg. Autografts were first reported in 1936 as interbody spacers for ALIF. Since then, bone grafts were commonly used for ALIF. However, ALIFs were not commonly performed due to variable reported outcomes. A pilot study in 1971 reported the use titanium mesh blocks as interbody implants in 6 patients. No articles reporting the use of integral fixation for SA-ALIF implants were found before the development of the HH in 1984. CONCLUSIONS: The HH was the first synthetic SA-ALIF implant developed. Since the HH, multiple SA-ALIF implants have been designed. The benefits of integral fixation in a SA-ALIF device include immediate implant stability, ability to reduce and correct deformity postimplantation, prevention of implant migration, and increased implant-bony endplate contact for early osseointegration.

Evolution of the Anterior Approach in Lumbar Spine Fusion.

The anterior approach to lumbar spine fusion, termed anterior lumbar interbody fusion (ALIF), is becoming increasingly popular, with numerous recognized indications, well-defined advantages, and potential complications. From its first theoretical description in 1932 and the first operation published in 1933 to the more recently reported less invasive procedures, an anterior approach to the lumbar spine has many technical variations. Here we describe the evolution of the anterior approach to the lumbar spine, from a hugely invasive transperitoneal route to the current minimally invasive retroperitoneal approach. Many advantages have been advocated for the ALIF approach, and some issues about intraoperative and postoperative complications need to be evaluated in a more specific and homogeneous manner.

The History of and Controversy over Kambin's Triangle: A Historical Analysis of the Lumbar Transforaminal Corridor for Endoscopic and Surgical Approaches.

The transforaminal corridor in the lumbar spine allows access to the traversing and exiting nerve roots, the thecal sac, and the intervertebral disc space. Surgeons performing midline and minimally invasive approaches for lumbar interbody fusion access the disc space within the boundaries created by the exiting root of a segment and the traversing root after a complete facetectomy and removal of the pars interarticularis and lamina. Endoscopic surgeons and interventional pain management physicians approach the lumbar segment through a similar corridor, but with the bony anatomy intact. Although the boundaries of the corridor may seem the same, the angle of the trajectory and the bone work between the two differ. The overlap between these 2 distinct access corridors has led to an openhanded application of the term Kambin's triangle. Initially described for endoscopic approaches to the lumbar spine for microdiscectomy, this working triangle has been grafted into the transforaminal lumbar interbody fusion literature. Given the similarities between these corridors, it is understandable how the lines of this nomenclature have blurred. The result has been an interchangeable application of the term Kambin's triangle for a variety of procedures in the spine literature. The objective of the current work is to add clarity to the various lumbar transforaminal corridors. The term Kambin's triangle should be limited to percutaneous access to the disc space for endoscopic procedures in the intact spine and should not be applied to transforaminal lumbar interbody fusion after laminectomy and facetectomy. Instead, the term expanded transforaminal corridor should be applied.

Astronaut Michael Collins, Apollo 8, and the anterior cervical fusion that changed the history of human spaceflight.

In 1961, President John F. Kennedy declared that the United States would send a man to the moon and safely bring him home before the end of the decade. Astronaut Michael Collins was one of those men. He flew to the moon on the historic flight of Apollo 11 while Neil Armstrong and Buzz Aldrin walked on its surface. However, this was not supposed to be the case.Astronaut Collins was scheduled to fly on Apollo 8. While training, in 1968, he started developing symptoms of cervical myelopathy. He underwent evaluation at Wilford Hall Air Force Hospital in San Antonio and was noted to have a C5-6 disc herniation and posterior osteophyte on myelography. Air Force Lieutenant General (Dr.) Paul W. Myers performed an anterior cervical discectomy with placement of iliac bone graft. As a result, Astronaut James Lovell took his place on Apollo 8 flying the uncertain and daring first mission to the moon. This had a cascading effect on the rotation of astronauts, placing Michael Collins on the Apollo 11 flight that first landed men on the moon. It also placed Astronaut James Lovell in a rotation that exposed him to be the Commander of the fateful Apollo 13 flight.Here, the authors chronicle the history of Astronaut Collins' anterior cervical surgery and the impact of his procedure on the rotation of astronaut flight selection, and they review the pivotal historic nature of the Apollo 8 spaceflight. The authors further discuss the ongoing issue of cervical disc herniation among astronauts.

[History of the treatment of scoliosis]. / Histoire du traitement de la scoliose.

Scoliosis remains a challenge to treatment, in spite of continuous efforts since the earliest times. The author describes the technical innovations with added efficiency, but even today one cannot avoid treatment without instrumentation and fusion, an always difficult indication on account of the variety of cases. Research is very active worldwide and accounts for great expectations (the role of the melatonin complex, the genetics of evolution factors, or the imagery of the EOS system). For the more deformed however treatment still remains unchanged in its principle: correction and fusion.

Albert Dereymaeker and Joseph Cyriel Mulier's description of anterior cervical discectomy with fusion in 1955.

Anterior cervical discectomy with fusion (ACDF) is a very well-known and often-performed procedure in the practice of spine surgeons. The earliest descriptions of the technique have always been attributed to Cloward, Smith, and Robinson. However, in the French literature, this procedure was also described by others during the exact same time period (in the 1950s). At a meeting in Paris in 1955, Belgians Albert Dereymaeker and Joseph Cyriel Mulier, a neurosurgeon and an orthopedic surgeon, respectively, described the technique that involved an anterior cervical discectomy and the placement of an iliac crest graft in the intervertebral disc space. In 1956, a summary of their oral presentation was published, and a subsequent paper-an illustrated description of the technique and the details of a larger case series with a 3.5-year follow-up period-followed in 1958. The list of authors who first described ACDF should be completed by adding Dereymaeker's and Mulier's names. They made an important contribution to the practice of spinal surgery that was not generally known because they published in French.

The True Ponte Osteotomy: By the One Who Developed It.

STUDY DESIGN: Technique and applications. OBJECTIVES: To define the anatomy, biomechanics, indications, and surgical technique of the true Ponte osteotomy. SUMMARY OF BACKGROUND DATA: The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. It has become a widely applied technique in various types of spine deformities and a frequent topic of presentations at meetings and in scientific articles. Several of them offer unquestionable evidence of an incorrect execution, with consequently distorted outcomes and erroneous conclusions. A clearing up became essential. METHODS: Our original experience is based on a series of 240 patients with thoracic hyperkyphosis operated in the years 1969-2015, at first with a standard posterior Harrington technique and then by using the Ponte osteotomy with different instrumentations. A series of 78 of them, operated in the years 1987-1997, who had Ponte osteotomies at every level, is presented. RESULTS: The average preoperative kyphosis has been corrected from 80° (range 61°-102°) to 31° (range 15°-50°) by a substantial posterior shortening. CONCLUSIONS: A number of publications use the term Ponte osteotomy loosely for by far incomplete resections and mixing it up with Smith-Petersen's osteotomy. The true Ponte osteotomy is capable of producing marked flexibility in extension, flexion and rotation, justifying its wide use in thoracic deformities, mainly in scoliosis. An exact performance of the osteotomy with adequate bony resections, including the laminae, is an absolute condition to take full advantage of its properties. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Sacropelvic Fixation: When, Why, How?

The indications for sacropelvic fixation continue to evolve with emerging instrumentation technologies and advancing techniques. Common indications include long construct fusions, high-grade spondylolisthesis, sacral fractures, sacral tumors, and global sagittal and/or coronal imbalance among others. The authors' preferred technique is through use of a freehand S2-alar-iliac screw placement.

History of Spine Deformity in Turkey.

Spine deformities are among the most important spinal disorders, affecting health-related life quality. Although there are some studies in past centuries, most spine deformity-related studies and research has started in the last century. Many surgical techniques, performed between 1960 and 1990, made scoliosis a touchable pathology. These techniques started with Harrington"s system, wiring techniques, pedicle screw techniques, and all other universal techniques. Anterior and 360 degree techniques contributed to this process. The use of spinal osteotomies, and recent technologies such as magnetic rods, intraoperative neuromonitoring added much to the body of knowledge of literature and improved the outcome. Advancement has not been limited to surgery only and diagnostic advancements had also impact to this process. Surgical techniques performed in the west have been performed soon in our countries. Currently almost all surgical techniques for treatment of spine deformities can be performed in our country. This article reviews historical aspects related to the diagnosis and treatment of spine deformities in Turkey.