THE TREATMENT OF SCOLIOSIS – A BRIEF HISTORY

Krishna and the Gopis

The Hindu epic Srimad Bhagwat Mahapuranam, which dates from 3500 to 1800 BC, involves a myth in which Lord Krishna straightens the spine of Kubja, one of his devotees.  Kubja, who was hunchbacked, had spinal deformities in three places.  By pressing het feet down and pulling her chin upwards, Lord Krishna managed to straighten her spine.  This is the first reference to axial traction methods. 

The Gospel of Luke describes how on a Sabbath, Jesus was teaching in one of the synagogues, when he spotted a woman whose spine had been bent for 18 years.  When he laid his hands on her, her back immediately straightened.

The Scamnum

It was the great Greek physician Hippocrates (460-375 BC) who first described abnormal curvatures of the spine in “de Articulaciones” of the Corpus Hippocraticum.  

Hippocrates, who recognized that many varieties of curvatures may be seen in the spine of healthy people, pinpointed old age, pain,falls and bad posture as the cause of abnormal curvatures.

Mention was made of lateral curves of the spine, cause by the attitude in which the patients would lie. He designed two different types of traction devices, the Hippocratic Ladder, and a traction table called the Scamnum. 

In”De Articulaciones” mention is made of the fact that great damage could be done if this traction table were used by those who sought mischief purposely. Less well meaning people indeed used the table in later times as a torture device nicknamed “the rack“.

Six  centuries later, Galien (AD 130-200) did extensive research with regards to structure and function of the spinal cord and kidneys. 

He first used the terms Scoliosis, Kyphosis and Lordosis to describe specific deformities in the spine,and he was the first physician to describe back pain.

Galien’s message, that observation and investigation are the basis for medical research, is the foundation of modern medical research methods.

Ambroise Pare (1510-1590). the “father of French surgery“, was a barber-surgeon who worked on the battle fields. 

Perhaps his most important realisation was that a physician’s job should be to ease a patient’s suffering, a concept unheard of in his day. 

Among his many accomplishments, Pare developed a brace for Scoliosis , “to hide and correct defects”.

These early braces, metal corsets with holes to diminish their weight, were fitted and padded, and were changed as the patient outgrew them. 

Pare recognized bracing was not useful for patients whose skeleton had reached maturity. Braces are still used in the treatment of Scoliosis to stop the curves from progressing.

The French paediatrician Nicholas Andry (1510-1590), author of “Orthopaedia“, believed Scoliosis was caused by asymetric muscle thightness, and used corsets made from whalebone with padding at the placeof the protuberances, suspension, and postural approaches, in its treatment.

Other names mentioned in the history of Scoliosis are this of Jacques Delpech, a French surgeon, who used traction and exercise in the treatment of Scoliosis, rather than surgical methods, and this of Jules Guerin, a French orthopedic surgion who used to treat Scoliosis patients by controversial subcutaneous surgery.  Other techniques used included a plaster body cast which was applied while the patient was being suspended.

The Harrington Rod

The man who changed the face of Scoliosis treatment forever,was an American named Russel Hibbs (1860-1932), who was the first surgeon ever to perform a spinal fusion. 

In 1911, Hibbs performed surgery to prevent the progression of curvature of the spine in a patient with spinal tuberculosis. Three years later, Hibbs applied spinal fusion to patients with Scoliosis in order to halt the progression of their curvatures. 

In addition to the surgery, his patients were put on extended bed rest and had to wear plaster casting for sometimes up to one year.

The basis for modern surgery of Scoliosis was laid by Dr. Paul Harrington, who in the 1950′s performed for the first time surgery using the so called Harrington Rod. Dr. Harrington later chose to combine use of the rod with spinal fusion.

 

Viviane De Doncker / Chloe  Pieters

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