We live in an age where medical treatments are more advanced than ever before. With continuous research comes the increasing potential for cures to be found for conditions which were previously deemed incurable
There’s no doubt that a lot has changed. You need only step back in time a few years to see how the management and treatment of spinal cord injuries has improved.
What might have been a near death sentence during the beginning of the last century, now has a much better prognosis. Many people today manage successfully with a spinal cord injury and indeed thrive and live life to the full.
Here we put things into context and take a closer look at how spinal cord injury treatment has progressed from the beginnings of civilization to the present day.
The earliest mention of treating spinal cord injuries and paraplegia dates back to 3,000BC in Egypt. Hippocrates, around the fourth century BC, mentions using traction to help with a spinal injury and, in 7th century AD, the first mention of a laminectomy (removing a vertebrae) is found.
The demise of the Roman Empire, unfortunately, meant that many medical advances were prevented from reaching areas like Europe but they still thrived in other parts of the world such as the Middle East.
Prior to the Renaissance, medical practice was limited and it wasn’t until 1230AD that we started to see more mention of spinal injuries in the literature of the time.
This was provided by Roland of Parma, who talked of using manual extension to treat spinal fractures. He was also the first in written history to talk about early intervention and its importance. By the 16th century, Ambroise Paré was suggesting using laminectomy for treating spinal injuries.
Spinal cord injury treatment began to become more focused when medical practices as a whole improved as we entered the 19th century. In the UK, it gave rise to greater expertise in the shape of individuals such as Astley Cooper and Charles Bell.
The two neurologists argued about the potential of laminectomy with Bell being the more progressive in his approach to SCIs. He believed that the damage occurred at the moment of injury and wasn’t because of pressure that could be relieved by removing a vertebrae.
He also identified secondary issues associated with spinal cord injuries, such as urine retention and renal tract inflammation, that could contribute to mortality. Whilst there was little in the way of improved treatment of spinal cord injuries, our understanding did develop considerably during this time.
By the turn of the century, German doctor Wilhelm Wagner began writing about the formal management of spinal cord injuries. Like Bell, he was opposed to operating on the spine and believed ongoing management was key based on the extent of the injury.
One of the lesser-known unpalatable truths about the war is that it produced more spinal injuries than were seen in peacetime. This, however, provided more opportunity to study the injuries and led the UK, Germany and France to establish spinal injury clinics. It was also the first time that multi-disciplinary teams were put into effect to help manage injuries such as this.
Once the war ended, however, the UK scaled back it’s clinics and France and Germany seemed to take no further action.
In the United States, however, Charles Frazier used work carried out in Europe during the war to produce the first textbook on the subject, detailing over 700 cases. More than half the text was devoted to the physical management of spinal cord injuries.
The father of paraplegia treatment is generally thought to be Donald Munro, who set up the specialist SCI treatment center in Boston. His doctrine became the major driving force for spinal cord injury treatment and included maintaining care of the bladder as well as skincare to prevent pressure sores from developing.
One key aspect of Munro’s philosophy regarding the treatment of SCI patients was to enable them to take care of themselves and lead productive lives once they had recovered from their acute injury.
World War Two once again led to an increase in clinics, not only to deal with soldiers injured in battle but civilians caught in the crossfire.
Units were set up in the UK to deal with spinal cord injuries and neurologists such as George Riddoch, who had seen first hand the effect of SCIs in the first war, were involved in setting up and running them.
One of the main founders of modern spinal cord injury treatment is considered to be German neurologist Ludwig Guttmann. Unable to practice because of his Jewish heritage and the rise of Hitler, Guttmann escaped with his family to the UK.
At Stoke Mandeville Hospital, he recognized the need for specialized units for dealing with spinal cord injuries, immediate treatment and aftercare for the individual. He also recognized the need for physiotherapy and continuous monitoring for patients. Many of the procedures that he put in place are still utilized today in modern spinal injury units across the world.
A number of inspiring individuals in the 19th and 20th century were involved in putting together the spinal cord injury practice that we see today. Without them, many of the advances that have been made in recent years might not have been possible.
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