2010 CNS Presidential Address Neurosurgical Pioneers: Foundation for Future Innovation

Abstract

This morning, I wish to briefly review with you the sputtering start of spine care and surgery dating back to ancient Egypt and Greece, through the Medieval period, up to the meteoric development occurring in the past few decades. Although a comprehensive review is not possible in such a short time, and although there are some well-known names I need to leave out, I would like to share with you some interesting highlights in the history of spine surgery. In recent decades, wise and forward-thinking leaders in neurosurgery realized the need to dramatically advance the education, training, and science of spine surgery. The technological advances have been astonishing. But the remarkable success of the past few decades has come with many problems, challenges, and roadblocks. Some pressures such as the federal government, the legal profession, the media, and even fellow physicians have been external. Many problems are internal, having been created by us. To ensure the continued success and development of the field of spine surgery, everyone in this room needs to accept important responsibilities as individuals. Among the first medical writings ever discovered that describe the treatment of spinal disorders is an Egyptian papyrus from the mid-1800s BC. 1,2 This papyrus was acquired by a shady relics dealer named Edwin Smith (for which it is still named) and was ultimately translated by Henry Breasted in 1930. The papyrus presented 48 medical cases; 4 were related to brain and spine injuries. The Egyptians clearly understood the relationship between brain and spine injuries and their effect on the function of the body. Complete injuries were thought to be hopeless and were not treated. Incomplete injuries were treated with prostrate positioning and binding the area with fresh meat and then honey until recovery. More than a thousand years later, the Alexandrian School was established in Greece. Cadaveric dissection and didactic teaching developed. War and other violent conflicts produced innumerable spine injuries. Hippocrates advocated treatment of incomplete injuries with rack and gravity reduction and sudden, violent ‘‘jolting’’ techniques known