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History of spinal problems and treatments?

DonnabeDDonnabe Posts: 595
edited 06/11/2012 - 8:56 AM in Matters of the Heart
It seems to me as though a lot of people have spinal problems these days.

Do you think there is a greater number of people that have spinal problems now than there was say 100 or more years ago? If so, why? What is the history of spine problems? Historically, what were some of the treatments? Who invented surgery such as spinal fusion?

If someone was a "spiney" 100 or more years ago did they get institutionalized? How was their pain taken care of? Did they ever even know what the cause of their problem was? Was it different for men than women?

I watched Medical Mavericks- Anesthesia on youtube and that was very interesting... I recommend it to everyone.

If you have any answers, or even any guesses, let me know! I would love to know the history behind spine problems and treatments.
ACDF C4-5 June 23rd, 2011

Another surgery in the near future. I am 26 years old.

Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg


  • I've been reading a lot of old English history books and they had lots of lumbar issues back in the day (11th century and on is what I read), having to haul so much by hand and even just carrying a baby during pregnancy.

    The painkiller of the day was a very hot stone rolled up in leather and placed on the lumbar area that was painful. They also had "healers" (if they weren't burned as being a witch) that gathered healing herbs such as poppies, crushed them and made tincures for those in extreme pain. Other than that, they just worked through it or rested as much as possible.

    You can just imagine that back in those days, they didn't have the luxuries that we do now, all lifting and carrying was done by hand, washing clothes in the river or stream, cooking in a big pot that had to be lifted on to a pothook over the fire, etc. Nobody thought about ergonomics and the logistics of how to lift or carry to save your spine.

    So that's the part that I know of. Sounds so barbaric, doesn't it? But bleeding was the cure during that time and lower back pain wasn't something that they'd bleed for.

  • Found this interesting read on The Burton Report

    Leon Wiltse, in his chapter on the history of lumbar spine stabilization (Lumbar Spine Surgery, Editors White AH et al, St. Louis: C.V. Mosby, 1987) identified Drs. Fred Albee and Russell Hibbs, orthopedic surgeons from New York City as the first surgeons to employ autogenous bone for the purpose of bone arthrodesis in 1911.
    Albee used tibial grafts between spinal processes to stabilize the spine. Hibbs, on the other hand, did not use tibial grafts but created a "feathered fusion" (his own description) in which, he "feathered" the lamina and decorticated the facet joints and then added morsalized bone derived from the local dorsal spinous processes. Hibb's technique represented the very first documented example of flexible stabilization utilizing autologous local bone for reconstructive purposes. From the work of Albee and Hibbs posterior spinal stabilization utilizing autologous bone became surgical standard procedures.

    Until recently all spine stabilizations have been incorrectly referred to as "fusions." This situation changed in 2004 when the American Medical Association in its Current Procedural Terminology publication eliminated the term and replaced it with the comprehensive term "arthrodesis."

    Burns in 1933 (Anterior Lumber Interbody) and Briggs and Milligan, Cloward and Jaslow (Posterior Lumbar Interbody Arthrodesis) added the interbody approach and in the 1930s metallic implants were first introduced. The pioneers in the development of metallic internal fixation devices were Harrington, Knodt, Larrick, Luque, Judet, Roy-Camille, Louis, Magerl, Kraag, Zielke, Strempel, Cotrel, Dubousset, Steffe, Wiltse and Selby.

    The classic intent behind Albee's "fusion" was to create a rigid union between vertebral segments in order to correct segmental dysfunction or instability. While rigid stabilization has been a blessing for many patients disabled by trauma or destructive disease (i.e. cancer, tuberculosis, scoliosis, deformity etc.) it has been the cause of many failed back surgery patients when applied in the management of multi-level degenerative disease. Shown to the left is an example of an "arthrodesis, posterior technique" utilizing the 2004 American Medical Association, Current Procedural Terminology.

    Because disc herniation was recognized as usually being associated with a dysfunctional, or hypermobile vertebral segment it became, in the 1940s, standard practice, at the Mayo Clinic, in Rochester, Minnesota (as well as some other institutions in the United States) to routinely perform posterior arthrodesis following routine discectomy. These autologous bone grafts were regularly harvested from the patients iliac bone crest (the pelvic rim). Routine bone "fusion" with discectomy was used for many years but "fell into disuse" when studies showed that the patients with this did not appear to fare any better than those with discectomy alone.

    The reason for harvesting bone from the sacral iliac crest area was that it was the most readily available autogenous donor bone available to surgeons in the large quantity required.

    The "down-side" of using the ileum as a harvest site for autogenous bone has been the creation of additional problems for the patient. These have included:
    Routine Post-Incisional Pain
    Complex Regional Pain Disorders due to Possible Neuroma Formation
    Possible Infection
    Possible Post-Operative Local Hematoma
    Possible Injury to the Sacro-Iliac Joint
    Possible Injury to Pelvic Ligaments
    Possible Pelvic Soft Tissue Problems i.e. Tissue Hernia Through Inner Table Defect
    Possible Gait Disturbances (Usually Seen in Older Patients)

    The classic bone "fusion" has always been a relatively crude and bloody procedure involving significant tissue disruption and long periods of hospitalization, immobilization and prolonged recovery . In the 1950s-1970s these patients were often hospitalized for weeks and then discharged on bed rest, in body casts and braces, for many months of continued bed rest. If rigid bone union did not occur the procedure was considered to be a failure and this alone often led to additional surgical procedures to achieve a "solid fusion." What has been the success of this procedure? The incidence of non-union through the years has been variously reported as being 0-68%. Metallic instrumentation was introduced as a means of creating faster, and better, solid fixation. It was found, in the early attempts of instrumentation use, that the devices being applied were less-than-ideal in establishing rigidity and that the spinal forces being brought to bear on these devices were far greater than anticipated. As a result of these data the instrumentation was progressively strengthened. This was particularly true for the pedicle screw systems.

    In the same way that after Drs. Dandy, Mixter and Barr documented the concept of the herniated disc (often to the exclusion of considering another diagnosis such as lateral spinal stenosis) it was, and in some case continues to be, accepted that rigid and solid arthrodeses were good and anything less was bad. It did become apparent, in time, that "hard" fusions placed significant stress on adjacent segments. Sometimes the effects of this could be dramatic. More often these effects were less dramatic and consisted of stress related segmental degeneration above (or below) the rigid arthrodesis. In fact the term "transitional syndrome" was adopted to describe this common complication. Not infrequently, this syndrome requires additional surgery. Information regarding this potentially serious situation is only rarely communicated to patients prior to surgery.

    As the curtain descended on the twentieth century spine stabilization technology finally began to advance. The greatest benefactor of rigid spine fixation has been the patient experiencing spinal trauma, scoliosis and deformity. Those who have benefited the least from rigid spine stabilization have been those with multi-level degenerative changes throughout the spine (i.e. multi-level degeneration from genomic and geriatric conditions producing neurologic involvement). In the latter group of patients rigid instrumented fixations as a means of treating discogenic pain have been finally identified as a "means of producing failed back surgery patients at an alarming rate"(The Lippincott Williams & Wilkins BackLetter, Vol. 19, Number 7, July, 2004, pp. 79) and the medical profession is only now coming to this realization.
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  • That is all very interesting!
    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
  • Donnabe said:
    It seems to me as though a lot of people have spinal problems these days.

    Do you think there is a greater number of people that have spinal problems now than there was say 100 or more years ago?
    1. Sedentary life style. Too many couch potatoes, too many jobs where people sit all day.

    2. Considering the above and the trend. Too many overweight people. Since obesity is becoming more prevalent. Expect more bone/joint issues because the spine is holding too much weight. The body mass and the frame need to be balanced.

    100 years ago people most likely had back problems more related to the hard physical work they had to do to survive.

  • I do agree that obesity and sedentary lifestyle causes more spinal issues but there has to be something genetic too.

    For example, I am 24, I am maybe 10 lbs overweight, and not sedentary. I have a very active job, and before my spinal issues I was very physically active.

    My mother has very bad spinal problems through her whole spine, she is 50 years old, never been overweight a day in her life and always very active.

    I do see this a lot.
    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
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