Spinal Cord Injury: Treatments and Rehabilitation
Hope Through Research
A Short History of the Treatment of Spinal Cord Injury
Accounts of spinal cord injuries and their treatment date back to ancient
times, even though there was little chance of recovery from such a devastating
injury. The earliest is found in an Egyptian papyrus roll manuscript written in
approximately 1700 B.C. that describes two spinal cord injuries involving
fracture or dislocation of the neck vertebrae accompanied by paralysis.* The
description of each was "an ailment not to be treated."
Centuries later in Greece, treatment for spinal cord injuries had changed
little. According to the Greek physician Hippocrates (460-377 B.C.) there were
no treatment options for spinal cord injuries that resulted in paralysis;
unfortunately, those patients were destined to die. But Hippocrates did use
rudimentary forms of traction to treat spinal fractures without paralysis. The
Hippocratic Ladder was a device that required the patient to be bound, tied to
the rungs upside-down, and shaken vigorously to reduce spinal curvature. Another
invention, the Hippocratic Board, allowed the doctor to apply traction to the
immobilized patient's back using either his hands and feet or a wheel and axle
arrangement.
Hindu, Arab, and Chinese physicians also developed basic forms of traction to
correct spinal deformities. These same principles of traction are still applied
today.
In about 200 A.D., the Roman physician Galen introduced the concept of the
central nervous system when he proposed that the spinal cord was an extension of
the brain that carried sensation to the limbs and back. By the seventh century
A.D., Paulus of Aegina was recommending surgery for spinal column fracture to
remove the bone fragments that he was convinced caused paralysis.
In his influential anatomy textbook published in 1543, the Renaissance
physician and teacher Vesalius described and illustrated the spinal cord in all
its parts. The illustrations in his books, based on direct observation and
dissection of the spine, gave physicians a way to understand the basic structure
of the spine and spinal cord and what could happen when it was injured. The
words we use today to identify segments of the spine - cervical, thoracic,
lumbar, sacral, and coccygeal - come directly from Vesalius.
With the widespread use of antiseptics and sterilization in surgical
procedures in the late nineteenth century, spinal surgery could finally be done
with a much lower risk of infection. The use of X-rays, beginning in the 1920s,
gave surgeons a way to precisely locate the injury and also made diagnosis and
prediction of outcome more accurate. By the middle of the twentieth century, a
standard method of treating spinal cord injuries was established - reposition
the spine, fix it in place, and rehabilitate disabilities with exercise. In the
1990s, the discovery that the steroid drug methylprednisolone could reduce
damage to nerve cells if given early enough after injury gave doctors an
additional treatment option.
Next: What Is a Spinal Cord Injury? »
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From the Doctors at MedicineNet.com  |
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Last Editorial Review: 9/13/2007
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