Samstag, 17. Oktober 2015

History of prolapsed disc treatment: Volume 2

The posterolateral approach to the spine

 The basis for the treatment of herniated discs through the posterolateral access to the foramen intervertebralis was created by needles gather tissue material from the disc by biopsy. This approach was described for the first time in 1955 by Professor Ottolenghi, an Orthopedist from Buenos Aires.

                                                                Professor Ottolenghi

Biopsy of bone material for the diagnosis of tumors was performed by Mixter 1922, Ward and Fokner 1927. Robertson and Ball devised a technique of vertebral needle biopsy in 1935. The development of a thin Trephine by Siffert and Artkin improved biopsy of bone tumors significantly in 1949.

In 1955 Ottolenghi gathered tissue material of vertebrae using longer and finer biopsy needles and trephines, which he developed especially for this purpose. Related to their dimensions they allowed the postero lateral (tissue protecting) approach to the spine. This approach is still used till today. The break through for this approach came with image guided systems like c-arm x-ray and CT.

Aspiration Biopsy of the spine / Ottolenghi: J.Bone Jt Surg 51 A 1531 - 1544 (1969)
Closed Vertebral Biopsy, I.S. Fyee, A.P.J. Henry, R.C. Mulholland, 1983, British Editorial Society, Bone and Joint surgery 0301-620X/83/2021-140
Magerl F, Witzmann A, Komplikationen dorsaler Zugänge zur Lendenwirbelsäule und deren Verhütung: Der submuskuläre Zugang. Trauma Berufskrankh 2005-7 (Suppl 2) 292-298

The technical development of the application of biopsy gegann with the invention of hollow needle and syringe.
1713 the french eye doctor D. Anela used a lachrymal silver syringe, similar to todays models.
1817 the German surgeon Graefe introduced a trocar (trois quarts) with a triangular cut needle surrounded by a hollow needle for puncture into the vein.
1836 The Lyoner Doctor C.G. Pravaz developed together with the French manufacturer J.F. Charriere  also a syringe. The medication dosage was controlled by means of screw thread. Later a stamp was used instead of a screw thread, which is used till today.
1844 Scottish doctor A. Wood and docotor F. Rynd treated neuralgic pain with subcutaneous morphine liquids. The syringe was produced by the London instrument maker D. Ferguson. Ferguson developed the first glass syringe ago with graduated glass cylinder.

1860 The french instrument maker G.G.A.Lüer developed a syringe to which the needle is plugged. This principle is applied in addition to the record-bit on top until today.

Buess H., Zur Frühgeschichte der intravenösen Injection CIBA-Zeitschrift 9, (1946) 3594-3606
Price J. Dominique Anel and the small lachrymal syringe. Medical History 13 (1969) 340-354
Buess H, Die Entwicklung der subkutanen und intramuskulären Injektion, CIBA Zeitschrift 9 (1946) 3628-3635
Howard-Jones.N: A critical study of the origins and early development of hypodermic medication, Journal of History on Medicine and Allied Sciences 2 (1960), 201-249
Blake, J.B.: Ferguson´s hypodermic syringe. Journal of History of Medicine and Allied Sciences 15 (1960) 337 - 341

The technology of production of injection needles and syringes for medication and biopsy has been developed rapidly like all medical areas within the last fifty years. Cut shapes and special cannulas are used for different types of biopsy. These include fine biopsy, vacuum biopsy and forceps biopsy often associated with endoscopy.
A pioneer in the field of bone marrow aspirate was the Persians Ali Akbar Djamshidi. He is the originator of the jam-shidi puncture needle which is produced by many manufacturers and very well known by orthopedists and trauma surgeons around the globe.

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