THE CLASSIC: Anterior Spinal Fusion

Abstract

Professor Arthur Hodgson ("Hoddy") turned 75 years old in June 1990 (Figure not shown). This was the year of the 35th anniversary of the first anterior surgical approach for spinal tuberculosis. In 1955, three patients were surgically treated with this procedure and received follow-up treatment for several months. At this stage, the patients had solid healing of the bone grafts and no sign of paraparesis. It was then decided, on the basis of these initial surgical observations, to proceed. Since then, Hodgson's contribution has been legendary. A paper that reported the surgical treatment of the first 50 patients was published in the British Journal of Surgery in 1956. During the next few years, large series of patients were reported with dramatic recovery of Pott's paraplegia and a very high rate of anterior bone graft fusion. Doctor Hodgson, his wife Monica, and their five children arrived in Hong Kong in 1951. He had left Rochester, England, where he was a senior registrar, and sailed to Hong Kong to take up the post as lecturer in orthopaedic surgery within the Department of General Surgery at Hong Kong University. During these early years in Hong Kong, Hodgson also had to deal with endemic poliomyelitis, osteomyelitis, and all the Third World orthopaedic problems. His first assistant in these early years was Dr. Harry Fang. By 1960, his work was well recognized, and he was made the first professor of the new Department of Orthopaedic Surgery, separate from the Department of General Surgery in which he began this monumental work. I was fortunate to spend eight years as lecturer in the department, leaving at the end of 1975. During this period, there was a renaissance in spinal surgery that was solely attributable to the hard work and clear thinking of Hodgson. Not only did he think and write clearly (his papers are few in number, but classical in quality), but he provided a great stimulus and influence on many leaders in spinal surgery during the past quarter of a century, including Doctors John Hall, Kenton Leatherman, and the late Alan Dwyer. It is no secret that without Hodgson's continuing support for Dwyer's screw and cable technique, it probably would have failed. All told, he spent 24 years in orthopaedic surgery at Hong Kong University, 15 of these as professor and head of the department. This volume of Clinical Orthopaedics and Related Research is a tribute to Professor Hodgson. I personally thank those who made the effort to put together their thoughts. The spinal papers in this Symposium represent much of the latest contemporary thought in spinal surgery, and would have been strongly approved of and encouraged by Professor Hodgson himself. As he looks back during his years of contribution to spinal surgery, Hodgson can be more than gratified by the knowledge that this concepts and ideas have been disseminated throughout the world. His contribution and the development of the anterior approach to spinal tuberculosis remain a milestone; from this flowed the anterior approach for so many other diseases of the vertebral column as we know it today. Professor Hodgson died on November 16, 1993 at the age of 78. His leadership in spinal surgery will be sorely missed throughout the world.