In MedTech History: Spinal Fusion

As far back as the 5^th Century BC, Hippocrates, a Greek physician and the founder of scientific medicine, described spinal deformities consistent with scoliosis and proposed the first recorded treatment. In his writings, he provided a precise description of the segments and the normal curves of the spine, the structure of the vertebrae, the tendons attached to them, the blood supply to the spine, and its anatomic relations to adjacent vessels. Hippocrates’ list of spinal diseases includes tuberculous spondylitis, post-traumatic kyphosis, scoliosis, concussion, dislocations of the vertebrae, and fractures of the spinous processes. He devised three seemingly barbaric pieces of equipment for the correction of spinal deformities—based on the principles of axial traction and three-point correction—known as the Hippocratic ladder, Hippocratic board, and Hippocratic bench. His pioneering research and methods are considered the precursors of modern spinal surgery.

Fast-forward to 1891, just nine years before the turn of the century when Hawaii's King Kalakaua was succeeded by his sister, Liliuokalani (she served just two years, and then the islands were annexed to the United States). Also, American salesman, mechanical engineer, and inventor Whitcomb Judson developed the "clasp-locker" to save people the trouble of buttoning and unbuttoning their shoes every day. Today we know this device as the ubiquitous zipper! Basketball as a sport was also invented in this year by American physical education professor and instructor, James Naismith, using a soccer ball and two peach baskets as goals while trying to keep his gym class active on a rainy day.

Also in 1891, American orthopedic surgeon, Berthold Hadra, MD of Galveston, Texas, was one of the first surgeons to successfully fuse the spine of a patient suffering from a fracture dislocation. Hadra performed an internal operative spine immobilization by wiring together the spinous processes of the sixth and seventh cervical vertebrae. He credited his inspiration to a colleague, Dr. W. Wilkins, who had successfully performed a similar procedure three years prior on a patient with tuberculosis spinal deformity.

Known as one of the premier authorities on surgical practices, Hadra revolutionized spinal surgery as well as gynecological techniques. His books include The Public and the Doctor (1902), which stressed the importance of the relationship between patient and doctor, and Lesions of the Vagina and Pelvic Floor (1888), which describes an operation for the repair of injuries to the pelvic floor from childbirth.

In 1909, a German surgeon, Fritz Lange, MD, was the first to perform spinal fusion surgeries on scoliosis patients. Lange revolutionized spinal fusion practice by straightening the spine with celluloid bars, steel, and silk wiring, which is very similar to modern stabilization techniques. According to literature, this was before the days of inert metals, and when metal was used for internal fixation, there was a race between the bony healing and liquefaction of the bone around the internal fixation device. Then, in 1911, the field took another step forward when orthopedic surgeons from New York City, Drs. Fred Albee and Russell Hibbs, were the first to use autogenous bone for arthrodesis in the lumbar spine. Many of the early fusions by these surgeons were for progressive deformities from tuberculosis but were later expanded to scoliosis and fractures.

Today, technologies and minimally invasive techniques continue to improve in spinal fusion, and the procedure is performed on more than 450,000 US patients each year as an effective treatment for lumbar and cervical fractures, deformities or instability in the spine. According to 2015 statistics from the Agency for Healthcare Research and Quality (AHRQ), spinal fusion was the fifth most common inpatient procedure in the US (at 147 inpatient stays per 100,000), behind total and partial hip replacement (167 per 100,000), knee arthroplasty (236 per 100,000), circumcision (336 per 100,000) and cesarean section (387 per 100,000).

To read more on recent developments and trends in the orthopedic and spine surgical device space, see our publication, MedTech Strategist; also watch our publication Market Pathways for coverage of the important regulatory and reimbursement issues impacting this evolving market segment.

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