An approach to the milestones of spine surgery in Persian traditional medicine.

BACKGROUND: The diagnosis and treatment of spine disorders have been challenging for thousands of years in different nations and medical schools. Despite this long history, there are many information gaps in this regard. The current research deals with the milestones and progress of spine surgery from ancient times until now, emphasizing the innovations of sages in the Persian traditional medicine era. METHODS: The present study is based on searching original and library documents, data from databases such as PubMed, Scopus, and Science Direct, and search engines such as Google Scholar. RESULTS: In Persian traditional medicine, Rhazes (865-925 AD) was the first sage who applied spine surgery based on the innovative knowledge of Galen (second century AD) and Paulus Aegineta (seventh century AD). Hally Abbas (tenth century AD), by suturing two separated bones during spine surgery, and Albucasis (936-1013 AD), by inventing, describing, and drawing the surgical instruments involved in surgeries in this area, and also using cauterization in the treatment of children's hunchback, were the innovators of new methods. CONCLUSION: The modern knowledge of spine surgery is based on intelligent experiences and prominent thoughts from thousands of years worldwide. However, sometimes, these key points have remained hidden. This issue necessitates investigating this science in different schools and territories for comparative studies, identifying the firsts in the prominent points of this field, preserving the identity of sages and nations, and preventing scientific plagiarism.

Historical Perspective: Thomas E. Whitesides, Jr.

: Dr. Thomas Whitesides was a pioneer in general orthopedics and spine surgery. He brought the anterior approach to the United States in the management of thoracolumbar trauma, a revolutionary step at the time. At Emory, he taught 100s of residents and fellows using the Socratic method. Dr. Whitesides remains a valuable consultant for complex spine cases to this day.

Evolution of Minimally Invasive Lumbar Spine Surgery.

Spine surgery has evolved over centuries from first being practiced with Hippocratic boards and ladders to now being able to treat spinal pathologies with minimal tissue invasion. With the advent of new imaging and surgical technologies, spine surgeries can now be performed minimally invasively with smaller incisions, less blood loss, quicker return to daily activities, and increased visualization. Modern minimally invasive procedures include percutaneous pedicle screw fixation techniques and minimally invasive lateral approach for lumbar interbody fusion (i.e., minimally invasive transforaminal lumbar interbody fusion, extreme lateral interbody fusion, oblique lateral interbody fusion) and midline lumbar fusion with cortical bone trajectory screws. Just as evolutions in surgical techniques have helped revolutionize the field of spine surgery, imaging technologies have also contributed significantly. The advent of computer image guidance has allowed spine surgeons to advance their ability to refine surgical techniques, increase the accuracy of spinal hardware placement, and reduce radiation exposure to the operating room staff. As the field of spine surgery looks to the future, many novel technologies are on the horizon, including robotic spine surgery, artificial intelligence, and machine learning to help improve preoperative planning, improve surgical execution, and optimize patient selection to ensure improved postoperative outcomes and patient satisfaction. As more spine surgeons begin incorporating these novel minimally invasive techniques into practice, the field of minimally invasive spine surgery will continue to innovate and evolve over the coming years.

George Chance and Frank Holdsworth: Understanding Spinal Instability and the Evolution of Modern Spine Injury Classification Systems.

The concept of spinal cord injury has existed since the earliest human civilizations, with the earliest documented cases dating back to 3000 BC under the Egyptian Empire. Howevr, an understanding of this field developed slowly, with real advancements not emerging until the 20th century. Technological advancements including the dawn of modern warfare producing mass human casualties instigated revolutionary advancement in the field of spine injury and its management. Spine surgeons today encounter "Chance" and "Holdsworth" fractures commonly; however, neurosurgical literature has not explored the history of these physicians and their groundbreaking contributions to the modern understanding of spine injury. A literature search using a historical database, Cochrane, Google Scholar, and PubMed was performed. As needed, hospitals and native universities were contacted to add their original contributions to the literature. George Quentin Chance, a Manchester-based British physician, is well known to many as an eminent radiologist of his time who described the eponymous fracture in 1948. Sir Frank Wild Holdsworth (1904-1969), a renowned British orthopedic surgeon who laid a solid foundation for rehabilitation of spinal injuries under the aegis of the Miners' Welfare Commission, described in detail the management of thoraco-lumbar junctional rotational fracture. The work of these 2 men laid the foundation for today's understanding of spinal instability, which is central to modern spine injury classification and management algorithms. This historical vignette will explore the academic legacies of Sir Frank Wild Holdsworth and George Quentin Chance, and the evolution of spinal instability and spine injury classification systems that ensued from their work.

Robotic Spine Surgery Where Did We Come From, And Where Are We Headed?

Robotic spine surgery has a number of potential advantages, including more precise preoperative planning, a high degree of accuracy in pedicle screw placement, and significantly reduced radiation exposure to the surgical team. Despite the potential advantages, many surgeons feel that it is still too early for the widespread adoption of this technology, citing increased cost, increased operating room time, and lack of necessity. Most spine surgeons will agree, however, that robotic technology is still in its infancy and that there will be a significant role for this technology in the future. Amidst this debate, it is important to understand the evolution of this technology from its initial inception to the present day, with a critical appraisal of the technology in its current form. It is important to consider the probable next steps in the development of this technology so that we may develop and shape this technology to most benefit our patients. This article reviews the history and development of robotic technology in spine surgery, critically assesses the technology in its current form, and explores the future directions.

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.

Spinal Deformities in Romantic Operas.

: The librettos of several of the most famous Romantic operas contain references to disease. These operas can serve as valuable sources of information regarding how spinal deformities were understood during the nineteenth century by physicians and lay persons alike. Original librettos of the operas "Rigoletto" (1851) by Giuseppe Verdi (1813-1901) and "La Esmeralda" (1836) by Louise Bertin (1805-1877) were analyzed. In both operas, spinal deformities of Rigoletto and Quasimodo are a central issue. In detail, Quasimodo could suffer from von Recklinghausen's neurofibromatosis, while Rigoletto could be affected by severe adolescent idiopathic scoliosis. The plays are an expression of the nineteenth century attitude toward deformity: the hunchbacks are ridiculed and excluded from the society due to their deformity. Thus, they are forced by society to act as ugly and evil beings. Although both Rigoletto and Quasimodo show an intense love, at the end of each opera, they are defeated by loss of this love. This is an evident sign that, despite its willingness to tackle the subject, nineteenth-century society was not still ready to attribute success or human value to people affected by disabilities.Level of Evidence: 5.

[History of the German Spine Society]. / Geschichte der Deutschen Wirbelsäulengesellschaft.

The objective of this article is to summarize the history of the German Spine Society (DWG). This society resulted in the year 2006 after several attempts from the fusion of two established German societies, which were dealing with topics around the spine, der "German Society for Spine Research" founded in the year 1958 and the "German Society for Spine Surgery" founded in the year 1987. This fusion was the beginning of a success story, as from this time on the annual membership increased so much that the DWG became the largest spine society in Europe and one of all spine societies worldwide.

[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.

Techniques of intraoperative monitoring for spinal cord function: their past, present, and future directions.

PURPOSE: The authors discuss the use of intraoperative monitoring of spinal cord function as an essential part of operations in which the spinal cord is at risk. Although early documented cases of intraoperative monitoring were during operations to correct spinal deformities such as scoliosis, intraoperative monitoring has also increased safety during other operations, such as tumor resection and arteriovenous malformation ablation. METHODS: The authors highlight details involved in monitoring spinal cord function intraoperatively and discuss historical, current, and future perspectives on the use of these monitoring techniques as an essential part of operations in which the spinal cord is at risk. RESULTS: Intraoperative monitoring techniques mitigate the risk of post-operative deficits to the spinal cord by detecting injuries before they become permanent and while they can be reversed. CONCLUSIONS: Intraoperative spinal cord monitoring is safe, cost-effective, and valuable in reducing post-operative sensory and motor deficit. This technique should continue to be refined and its use consistently applied in any procedure where injury to the spinal cord is possible.

Historical contributions from the Harvard system to adult spine surgery.

STUDY DESIGN: Literature review. OBJECTIVE: To document the historical contributions from the Harvard Medical School system to the field of adult spine surgery. SUMMARY OF BACKGROUND DATA: Despite the fact that significant contributions to the discipline of spinal surgery have derived from the Harvard system, no prior study documents the history of the Harvard spine services in a cohesive narrative. METHODS: This historical perspective reviews the history of adult spine surgery within the Harvard system and outlines the significant contributions made by orthopedic and neurosurgical practitioners to the field. Literature reviews were performed from historical works, as well as scientific publications to fashion a cohesive review covering the history of spine surgery at Harvard from the early 19th century to the present. RESULTS: The development of the spine surgical services at the three main Harvard hospitals, and significant spine surgical personalities within the system, are discussed, including W. Jason Mixter, MD, Joseph S. Barr Sr., MD, and Marius N. Smith-Petersen, MD. Substantial developments that have arisen from the Harvard teaching hospitals include the recognition of disc herniation as the cause of radicular symptoms in the lower extremities, the description of lumbar discectomy as a surgical treatment for radicular pain, osteotomy for the correction of spinal deformity, and the first attempt to create a systematic algorithm capable of informing treatment for cervical spine trauma. CONCLUSION: Despite humble beginnings, the surgeons and scientists at Harvard have influenced nearly every facet of spine surgery over the course of the last two centuries.

The importance of being a spinal neurosurgeon: evaluation of spinal surgery in Belgium between 2000 and 2005 and the creation of the Belgian Neurosurgical Spine Society.

BACKGROUND: As the scope of neurosurgical spinal operations has broadened widely, spinal neurosurgery is certainly the one of the fields of neurosurgery where the most changes are observed. Increasing health costs and an aging population will make this issue even more crucial in the future. METHODS: We reviewed the number of spinal procedures performed by neurosurgeons in Belgium between 2000 and 2005. During this period, the number of lumbar spinal operations for degenerative spinal diseases has increased by 20%, reaching more than 23,000 operations per year, among which 77% were decompressive surgeries, 43% posterior fusions, and 50% anterior fusions, all done by neurosurgeons. The neurosurgical prevalence is even more striking in cervical or intradural procedures. CONCLUSION: As a result we created a neurosurgical spine society to represent neurosurgeons who were otherwise almost absent from the political decision-making processes. These observations, not unique to Belgium, should encourage colleagues to play a pivotal role in all spine-related discussions with healthcare providers, state or private, to get involved in teaching spinal surgery, and to participate in clinical and laboratory research leading to the publications that are essential to put forward the contribution of neurosurgeons in spinal surgery.

Cervical spine surgery in the ancient and medieval worlds.

The early historical literature on cervical spine surgery lacks printed material for review, and we can rely only on pathological material from the prehistoric period that has survived as a result of anthropological investigations. After the introduction of Egyptian and early Hellenic medicine, some written material became available. This paper reviews these materials, from both books and manuscripts, in an effort to understand the development of cervical spine surgery from the perspectives of the personalities involved and the early surgical practices used. The review thus considers the following five eras of medicine: 1) prehistoric; 2) Egyptian and Babylonian; 3) Greek and early Byzantine; 4) Middle Eastern; and 5) medieval.

Absent cervical spine pedicle: report of a case in a mediaeval skeleton.

This paper presents a first dry-bone study of the anatomy of an absent cervical spine pedicle and briefly reviews the literature involving this anomaly. The case study is of the absence of the right cervical spine pedicle at C6 in a mediaeval skeleton from England. Key features of the anomaly, including, in addition to the absent pedicle, dysplasia of the ipsilateral transverse process, dorsal displacement of the articular pillar, and reversal of the ipsilateral facet articulation with the supra-adjacent vertebra, are illustrated. Compromise of cervical spine stability is demonstrated. Literature review revealed 69 cases of absent cervical spine pedicle; all were unilateral, and there was no side or gender preference. The current case is a first description of an absent cervical spine pedicle in an archaeological skeleton. It indicates the presence of the anomaly in a European population more than 600 years before the first clinical description. Absent cervical spine pedicle appears to be a rare variant today; the paucity of archaeological cases shows that this was also the case in the past.