Fractures of vertebrae are often compared to compressive damage of the cranial bones. In 1752 Heister recommended laminectomy on the spinal column to decompress the spinal cord, in analogy to trepanation in treatment of injuries of the skull. In 1762 A. Louis performed successful surgery on the spinal column consisting in removal of bone fragments from a shot wound. The first laminectomy, attributed to R. Cline, had fatal outcome, as did similar operations by American and English surgeons. In 1829 Alban G. Smith (of Danville, Kentucky) performed the first successful operation followed by partial recovery from paralysis [83], [108], and similar results were subsequently reported by Maydl in 1882, Chipault in 1890, Lauenstein in 1888 and Dawborn in 1889 [116]. In a statistical series of 31 spinal operations published by Carl Wagner in 1879, only 6 patients survived, and none manifested neurologic improvement [108]. Successful decompression of the spinal cord was attributed to Sir Victor Horsley, who operated on a patient with a tumor of the spinal cord which had been localized and diagnosed before operation by Gowers. The first attempts to stabilize the spinal column were made by Hadra, Chipault , Wilkins, Lange and Henle, using metal wire, silver plates and celluloid [68], [108], [116], [135]–[137]. Lauenstein, Dawborn and Maydl used silk thread on the spinous processes. In 1945 Novak of Brno devised a method of stabilizing the spine by means of a wire loop (‘cerclage’) [10], [135], [136], [207]. Operative stabilization of the spinal column with wire loops in paraplegics greatly facilitates nursing of these patients and allows their earlier rehabilitation [207]. The method had many advocates and was widely used in many surgical centers. Fixation of an unstable spinal column by means of wire loops can be done in all segments of the column, cervical, thoracic, and lumbar; they may be associated with bone grafting. However, the follow-up is relatively disappointing because mechanical stabilization may result in secondary displacement; wire, being subject to the laws of fatigue of metals, often breaks. Too tight application of the wire loops may cause necrosis of the spinous processes. Nevertheless, the method won the approval of many Czech, Polish and French surgeons and was widely used in the 1960s [109], [135], [136].


Spinal Cord Spinal Cord Injury Nerve Root Spinal Canal Spinal Column 
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© Springer Science+Business Media New York 1977

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  • Janusz Makowski

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