Mittwoch, 7. Oktober 2015

History of prolapsed disc treatment


Knowledge of the lumbar herniated disc as a common cause of sciata is due William Jason MIXTER (1880 - 1958) and Joseph Seaton BARR (1901 - 1963) On September 30, 1933, the authors working at the Massachusetts General Hospital in Boston refered about  "Ruptures of the interverebral disc with involvement of the spinal canal". When etiting their 25 cases of "spinal cord tumors" they succeeded 19 times the histological detection of nucleus pulposus or anulus fibrosus and only 6 times found themselves cartilaginous or unclussifiable tumors.

Excerpt from the lecture of 1933

That, not an uncommon cause of symptoms is the herniation of the nucleus pulposus into the spinal canal or the rupture of the intervertebral disc, as we call them preferably.  The fact that the lesion was often misunderstood as cartlaginous, emananting from intervertebral disc regeneration.That in reality the rupture of the intervertebral disc ist much more commen than the neoplasia, the treatment of this disease is in our series in the 3 to 1 ratio... it is a surgical one and that the results obtained, provided that the compression was not to long, are very satisfactory".

(Mixter WJ, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. New Engl. J Med 211:210-215)

Early Operation techniques by Krause

The first actual operations of lumbar disc herniation were made in the early 1900s, the herniated discs still were called "Ekchondrome" or " Ekchondroma"also "cartilaginous tumors"

The type of surgical technique semms from todays´perspective adventurous (Krause 1911): Macro Surgical, so to the naked eye, the dura mater was slit-shaped opened, the cerebrospinal fluid was drained, then the intradural space was inspected, then the front of the Dura opened, and then the herniated disc was removed.

The patient, described by Krause had so far recovered from the surgery that he could lead a normal life 10 month after surgery. What remained was Peroneuspararese which could however, have also existed prior to the OP (Literature: Krause 1911, pp 717 - 719)

Operation technique by Mixter - Barr

For the laminectomy a skin incision above the center line of the spinous process is performed. The cout continous through the supraspinous ligament up to the tips of the spinous processes. There after, the spinal straps are removed, after that the lateral muscle packages are peeled off by chisel or rasp and also the lateral muscels till to the angle joints The muscels are held by a retractor aside and the spinous process is removed with a Luer forceps. Subsequently, the vertebral arches are detached with a laminectomy punch. Through removal of the spinous process and the arch the underlaying nerve was released. This operation technique has been used, with variations, till the end of the sixities last century for prolapsed disc treatment. Nowadays laminectomy is used mainly for tumors and severe spinal stenosis. Prolapsed disc is treated with more advanced operations techniques.


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