Cervical spine surgery: an historical perspective

Abstract

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.

Figures

Fig. 1A–B

(A) A photograph of Alessandro Codivilla with his signature is shown. (B) The cover of the book by Vittorio Putti on the writings of Alessandro Codivilla is shown. Images courtesy of the Historical Section of the Library of the University Campus Bio-Medico of Rome. Reprinted with permission of Licinio Cappelli Editore from Putti V, ed. Scritti medici di Alessandro Codivilla. Pubblicati dall’Istituto Ortopedico Rizzoli. Vol Archivio ed atti della società italiana di chirurgia. XX adunanza, 1907. Bologna, Italy: Licinio Cappelli Editore; 1907.

Fig. 2A–B

(A) A lateral radiographic myelogram shows compression from C5–C6 cervical disk herniation. (B) A photograph of the operative field is shown after laminectomy, opening of the posterior aspect of the dura (solid arrow), and section of the dentate ligaments. After retraction of the spinal cord with a probe, it is possible to appreciate the prominence of the herniated disc (dashed arrow). Removal of the hernia occurred via an extradural approach. Reprinted with the kind permission of the Società Italiana di Ortopedia e Traumatologia from Fineschi G. Clinica e terapia delle protrusioni del tratto cervicale. Paper presented at Atti 51° congresso della Società Italiana di Ortopedia e Traumatologia: Le protrusioni posteriori del disco intervertebrale. October 22–25, 1966; Catania, Italy.

Fig. 3A–C

(A) A preoperative myelogram shows spondylosis and myelopathy of C3–C4, C4–C5, and C5–C6 in a 62-year-old man. (B) A myelogram shows the spine 12 years after multiple-level decompression and fusion had been performed in 1969. (C) The anterior aspect of the posterior longitudinal ligament is exposed and covered with Surgicel® (Ethicon, Inc, Somerville, NJ). Reprinted with the kind permission of Springer Science + Business Media from Boni M, Denaro V. The cervical stenosis syndrome with a review of 83 patients treated by operation. Int Orthop. 1982;6:185–195.