History of Spine Surgery
The history of spine surgery is intertwined with the history of orthopedic surgery. Though today orthopedics is an area of medicine focused on the musculoskeletal system, or the bones, the practice has its origins in pediatric care. The word orthopedic comes from two Greek words — ortho meaning “straight” and pedic meaning “child.” The aim of early was to fix deformities in children so they would grow up to have strong, healthy bones.
Now, spine surgery is a specialty area of medicine that is more often practiced on adults. Whether due to injury or deterioration, many adults end up with back pain. Advances in orthopedic medicine make it possible to correct many of these problems and relieve the patient’s pain.
The number one spine surgery procedure performed in hospitals is a spinal fusion — and it’s rising. In 2007, 380,000 procedures were performed, but in 2011, the number of spinal fusions increased to 457,500. During this same period, diskectomies also increased, from 332,500 to 369,900 procedures.
The third most prevalent type of spine surgery is the insertion of a device, like an artificial disc or plates and rods. These insertions are often done in conjunction with a fusion.
These procedures are all possible due to modern advances in orthopedic surgery techniques, and the field of spine surgery continues to change. What was impossible a generation ago is now done successfully every day. Some modern spinal procedures no longer require hospitalization.
Laser Spine Surgery History
Fossil evidence shows that orthopedics was practiced in ancient times. Various civilizations understood the importance of straight bones and applied their own primitive techniques to assisting the healing of broken bones. Early splints were made or rawhide or clay and effectively held bones in place while they healed. Crutches were even fashioned to avoid weight-bearing.
The ancient Greeks attempted to treat club feet and scoliosis with their rudimentary understanding of bones. They understood these conditions in children could be corrected. Their remedies, especially for scoliosis, were not always successful, but their efforts suggested a crucial understanding of how bones transform with growth.
The 20th century brought some important improvements to orthopedic medicine. The X-ray help better determine the proper diagnosis, and better means of fighting infection meant more patients survived injuries and surgery. The concept of the ambulance rushing injured patients to medical care, perfected during the two world wars, also help orthopedic surgeons with better outcomes.
Through the mid-1900s, techniques for repairing broken bones were developed, partially through the experience of war. The amputation of badly damaged limbs was perfected, and procedures to repair difficult fractures also became more successful. The ability to repair hip fractures and replace damaged joints began to develop during this period.
Spinal surgery techniques also began to advance. The initial focus was on improving or repairing issues in the lumbar spine resulting from degenerative disc disease. Through the practice of removing lumbar hernias or repairing ruptured discs, doctors developed a better understanding of the discs that sit between vertebra in the spine.
Spinal surgery advanced from the lumbar spine to the cervical spine. Damaged discs were successfully removed from the cervical spine, although the risks of damage were greater in this upper region of the spine. Manipulation of the spinal cord in the lumbar region was considered safer and was to be avoided in the cervical spine.
In the 1970s, a new round of technological advances in medicine moved spinal surgery forward. Instruments for imaging and scanning the body improved diagnosis of spinal issues. The incorporation of a microscope and the use of magnetic resonance imaging (MRI) made spinal surgery more precise.
Instruments were also introduced to spinal surgery in the 1970s and 1980s that allowed surgeons to better protect the spinal cord during surgery. By monitoring the functioning of the nerve roots and providing the surgeon with an early warning signal, these instruments could prevent damage to the spinal cord. While screws or plates were being set, the surgeon could be assured the spinal cord was protected.
Modern spinal surgical techniques are a result of increased understanding of the spinal cord and the central nervous system. Neuroscientists continue to study and learn more specifics about how the central nervous system operates to protect or repair the spinal cord.
Continued advancements in medical technology improve spinal surgery today. Better and more natural implant devices are available, along with more sophisticated tools for completing surgery. Spine surgeons are now able to repair or rebuild parts of the spine that may be damaged by injury or disease. The materials used are much closer to natural substances, and the devices behave much more like actual parts of your spine.
The spinal fusion technique gained popularity in the early 1900s as a response to tuberculosis. The procedure was used to correct a spinal deformity created by the tuberculosis infection. The result was also a decrease in lower back pain.
Spinal fusion was developed as a remedy for spinal instability resulting from degenerated discs. As it was initially developed in the early 1900s, fusion was accomplished by attaching a piece of bone taken from elsewhere in the body to the back of the spine. The bone was to fuse one vertebra to another, bridging the gap of a damaged disc.
Wiring was also sometimes used to repair broken vertebrae and hold the spine stable. This hardware approach worked until the hardware failed. In many cases, the bone graft approach to fusion also failed.
The modern spinal fusion technique makes use of both a bone graft and hardware to secure the spine. The hardware holds the spine in place until the graft can take hold. Once the graft is secure, it prevents the spine from moving and putting too much pressure on the hardware.
The problem with spinal instability is that it can impinge the spinal cord. The vertebrae are meant to stack on top of one another and not move laterally. When one or two vertebrae are allowed to slide to the side, the central space for the spinal cord narrows, and the cord is endangered.
A spinal fusion replaces the structural integrity of the spinal cord, whether it is damaged by a broken vertebra or a degenerated disc. By holding the spine is its natural stacked position, a fusion prevents sideways sliding, nerve impingement and back pain.
History of Minimally Invasive Surgery
It has long been understood that surgery recovery times can be improved by minimally invasive techniques. General anesthesia carries certain inherent risks. The longer a patient is under general anesthesia, the more difficult it can be to bring the patient out and resume normal vital signs.
While the use of general anesthesia revolutionized surgery and makes many procedures possible that could not be contemplated without it, numbing the area of surgery without making the patient unconscious is favorable when possible. Many minimally invasive procedures can be accomplished with a local anesthesia to keep the patient comfortable. A conscious patient, in some cases, can even assist the surgical team by reporting sensations.
The other advantage to minimally invasive surgery is reduced recovery times that result from less muscle and tissue disturbance. Keeping incisions through skin and muscle small reduces the exposure to possible infection, and smaller incisions heal faster.
The key to developing minimally invasive spine surgical procedures was having the required technology. Surgeons still need to see the area they are on. With small incisions, instruments had to be developed that could be inserted to help the surgeon visualize the work.
Small incisions also preclude surgeons from working by hand. Since they cannot get to the spine with their hands, they needed tools that could fit in through the incisions and offer them the precision to manipulate the spine and the repair pieces.
Lumbar Disc Disease
Since open spine surgery was relatively successful and most patients tolerated it well, there was no rush to create minimally invasive procedures. Other areas of orthopedic surgery moved into minimally invasive techniques before they were adapted to spine surgery. The major developments in lumbar disc disease are:
- 1908 — First lumbar disk surgery performed
- 1964 — A chemical was developed to use as a nerve block in lieu of disc surgery
- 1975 — First procedure to partially remove a damaged disc through the skin
- 1983 — Discectomy procedure improved by use of new instruments and small incision
- 1985 — Disc decompression was achieved by partially removing disc material through the skin
- 1986 — instruments used in eye surgery were redesigned for minimally invasive spine procedures
The first area of focus was on lumbar disc disease. Operating on the lumbar spine was easier and less risky than the cervical spine and seemed an appropriate area for innovation. Lumbar disc disease was the prominent complaint, and surgeons attempted to adopt minimally invasive techniques to remove a damaged disc and relieve pressure on nerves in this region.
A chemical was developed that could be injected into the damaged disc that would dissolve part of the disc and relieve the pressure on the nerves. This treatment was used especially for sciatica, the painful compression of the sciatic nerve. The chemical injection could be given through the skin with just a local anesthesia.
This procedure was highly successful when used under the right conditions. Choosing the right patient was critical to success, but for those patients, it was a great relief. Other procedures for spinal decompression and pain relief were developed to work through the skin or with only a small incision.
Spine surgeons discovered that they could partially remove a damaged disc without opening the patient. A large tubular needle was inserted under local anesthesia to extract the disc material. This procedure was also effective. Over time, surgical instruments were developed for this specific purpose and visibility and accuracy increased.
Laser Spine Surgery History
Laser technology was developed and eventually applied to medical applications in the mid-1900s. The laser was used to assist with disc removal surgery. It was inserted through the skin with the needle and disintegrated the damaged disc. Short bursts of laser energy were applied to avoid overheating the surrounding tissue.
From the first laser disc removal procedure, laser technology in spine surgery has improved. Excessive heat is no longer a concern with the types of lasers used today. The laser assisted instruments evolved to be more precise and to improve visualization during the procedure. Here is a brief overview of laser spine surgery development:
- 1958 — Laser technology was developed
- 1984 — A saline manometer used to measure pressure between discs during laser procedure
- 1990 — Type of laser used for spine surgery was changed and it included an instrument for measuring pressure
- 1992 — A new type of laser was introduced for these procedures to be more precise
Current laser spine procedures pose less risk to the surrounding tissue and structures in the vicinity of the spine, especially the vena cava, aorta and iliac vessels that lie between the spine and the front of the body. A dye is injected into the discs so they are more visible, and the pulses of the laser can now be adjusted with greater precision, allowing very specific reshaping of the disc.
History of Disc Removal Techniques in Spine Surgery
The first minimally invasive disc removal procedure involved using existing equipment to draw material out of the disc with a big needle. Tools for this type of procedure were developed and refined in the late 1900s, similar to those used for arthroscopy joint surgery.
An instrument that is just 2.7 mm combines all the tools needed to diagnosis the problem and resolve it at once under local anesthesia. The tool carries a video camera to send images to a screen where the surgeon can visually assess the discs. Inflammation is removed with the same endoscope without removing and reinserting or inserting a second instrument.
Arthroscopic spine surgery presents some benefits over other procedures. It allows the surgeon to inspect the discs and other structures in the area that might be involved in nerve impingement. The procedure is also indicated for a variety of types of disc damage. Arthroscopy is not a successful technique for removing disc material that has migrated away from the disc space due to rupture.
Historic Spine Surgeries
Surgery on the spine is an intervention that began centuries ago. Most of the innovations in this field of medicine have happened in recent decades. As technology develops, it is applied to spine surgery with innovations and improved outcomes. Consider the advancement of technology for spine surgeries:
- 7th Century — First spine surgery in recorded history
- 1914 — The first surgery to correct scoliosis was performed in New York in 1914 by Dr. Hibbs. This surgical technique was used in France for at least 50 years before it came to the US.
- 1941 — Spinal fusion became a common spinal surgery
- 2000 — The first disc replacement surgery was performing in the US by Dr. Blumenthal
- 2010 — “Dirty Dancing” actress Jennifer Grey underwent four neck surgeries and then proclaimed herself pain-free for the first time since a 1987 car accident
- 2011 — Quarterback Peyton Manning underwent a controversial cervical spine surgery, then returned to football and won the Super Bowl in 2014
- 2012 — NBA player Dwight Howard underwent minimally invasive disc surgery and continues to be a standout player in the NBA
- 2014 — Pro-golfer Tiger Woods sustained an injury that required back surgery. After having part of a disc removed, Woods is back on the pro tour pain-free.
Professional athletes are perhaps the best example of the tremendous progress that spine surgery has made in recent years. In the 1950s, when President Kennedy underwent spine surgery to relieve pain caused by a football injury, his physical activity was severely limited. Following recovery from the surgery, he continued to experience some pain. He also had to wear a back brace and often used crutches in private.
Modern surgery techniques and a clearer understanding of how the spine works allow surgeons to relieve pain and return patients to the same level of activity they were used to. Minimally invasive procedures mean recovery time is shortened. Some procedures can even be performed on an outpatient basis or with a very short hospital stay.
Back Surgery Recovery Since 1950
Spine surgery was somewhat common in the 1950s but only for patients whose pain could not be relieved by any other means. More often, back pain was treated with strong painkillers and narcotics. Immobilization was often recommended for flare ups.
The standard approach to spine surgery in the 1950s was a large incision across the abdomen and through the body cavity to get to the spine. Surgeons had to disturb the intestines to gain access to the spine. Recovery time from this type of surgery was several weeks. Muscles were cut and had to heal, and there was a great risk of infection, both during the surgery as surgeons worked around the bowels and from the incision.
Spine surgery has come a long way from there. Today, many procedures are performed under local anesthesia without open incisions. Other surgeries may involve a small incision and general anesthesia, but recovery times are much more limited. Depending on the procedure, some patients go home the same day and are back to their normal activities within a week.
Modern spinal surgery techniques allow doctors to relieve back pain from most sources. Degenerative disc disease can almost always be repaired with a reduction or even complete elimination of pain. Vertebrae damaged by injury can be repaired or replaced. The spine can be fully stabilized using a fusion technique and a series of hardware specially adapted for spinal applications.
With the continuing advances in spine surgery, a patient’s activity level can be improved or restored at any age with minimal downtime. There is almost no reason to live with debilitating back pain, whether from degenerative disc disease or injury.
If you are experiencing neck or back pain, contact NJ Spine & Orthopedic for a consultation. Our specialists can diagnose the root cause of your pain and offer treatment options. There are a number of different non-invasive therapies that could ease your pain and help you return to your regular level of activity.