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Brief History of Therapy for Traumatic Spinal Cord Injury

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    Brief History of Therapy for Traumatic Spinal Cord Injury

    have we come along way?

    Brief History of Therapy for Traumatic Spinal Cord Injury

    In This Article

    Abstract and Introduction
    A Brief Review Of SCI Treatment

    A Brief Review Of SCI Treatment

    Egyptian Period

    The affliction and suffering associated with fractures of the spinal column and injury to the spinal cord have attracted the interest of the medical community since the dawn of civilization. The first references to spinal column injury and SCI are found in the writings contained within the Edwin Smith Surgical Papyrus (Fig. 1).[6,8,11,14] The document, dating to 2500 BC and obtained by the Egyptologist Edwin Smith in 1862,[8] is the first part of a textbook regarding bodily injuries, which are essentially described systematically from head to toe.[8] The book comprises a series of 48 case histories that provide insight into Egyptian medicine of 2500 BC. Six case reports (Cases 29–33 and 48) refer to injuries of the spinal canal.[6,8,11,14] The author describes, with great detail, the diagnosis and treatment of fractures, sprains, and open wounds involving the spinal column. Case 31 is thought to represent the first clinical report of SCI:

    Figure 1. (click image to zoom) Edwin Smith Surgical Papyrus Cases 29–31.

    If thou examinest a man having a dislocation of his neck, shouldst thou find him unconscious of his two arms (and) his two legs on account of it while his phallus is erected on account of it, (and) urine drops from his member without his knowing it; his flesh has received wind: His two eyes are blood-shot; it is a dislocation of a vertebra of his neck extending to his backbone which causes him to be unconscious of his two arms. . . . Thou shouldst say concerning him . . . an ailment not to be treated.[8]

    Clearly the author of this treatise, who is believed (by some) to be the great physician and architect Imhotep (and an army surgeon by others),[8] is a learned anatomist, physician, and surgeon. It is obvious from this narrative that the author possesses some knowledge of anatomy, physiology, neurology, and pathology, with the text's clinical description of paralysis, bladder incontinence, vasodilation, abdominal distention, and priapism. It is of great interest that no distinction is made, at this time, between spinal vertebral injury and the presence of the underlying spinal cord. This discovery is to come later. The prognosis for this injury, "an ailment not to be treated," remained the attitude of physicians for centuries.

    The medical record, in relation to SCI, is poorly documented between the Egyptian period and the rise of Greek civilization. The lethal nature of spinal vertebral injury and SCI can next best be illustrated in Homer's Odyssey, where he presents the character of Elpenor, who became inebriated, climbed on a roof, and fell when startled by his friends. In falling from the roof, he broke his neck "and his soul went to Hades."[6] Some references to SCI, from as early as 1800 BC, can also be found in the Hindu civilization, with the concurrent utilization of axial traction.[11] It appears, however, that the prognosis of these types of injuries did not change during this period.[6]

    Hippocratic and Galenic Period (500 BC–500 AD)

    Hippocrates (460–377 BC), considered both the father of medicine and orthopedics, discussed fractures/dislocations of the spinal vertebrae and their correlation to SCI (Fig. 2).[11,12,14] He is credited with some of the first clinical descriptions of chronic paralysis, with constipation, bladder difficulty, bed sores, and venous stasis of the lower extremities. He believed that poor outcomes associated with these patients were due to obstruction of the visceral organs, and he promoted special diets for the treatment of these clinical entities.[6,12] Additionally, Hippocrates is credited with developing methods for reducing spinal deformities by administering traction with the aid of his extension bench, the scamnun (Fig. 3).[11,12,14] This device, with various modifications, has been used in the treatment of spinal disorders throughout history, up to the present day. He believed that there was no reasonable therapy for individuals with fractures combined with paralysis and that they were destined to die.[11,12] Interestingly, he hypothesized that cure may be feasible if anterior reduction of the fracture was possible, a precursor to anterior surgical decompression.[11,12,14] What is not clear in the work of Hippocrates is the role and appreciation of the spinal cord. The basic science of this injury was still in its infancy.


    Wow, "an ailment not to be treated" I guess most modern physicians these days must have studied in medical school under the authority of the ancient Egyptians from their teachings nearly 4000 years ago, interesting.
    "Life is about how you
    respond to not only the
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    soul dies".~Liz Fordred