LITERATURE REVIEW

J Neurosurg Spine 31:775–785, 2019

History and advances in spinal neurosurgery

JNSPG 75th Anniversary Invited Review Article

Corey T. Walker, MD, U. Kumar Kakarla, MD, Steve W. Chang, MD, and Volker K. H. Sonntag, MD
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona

Insight into the historic contributions made to modern-day spine surgery provides context for understanding the monu-
mental accomplishments comprising current techniques, technology, and clinical success. Only during the last century
did surgical growth occur in the treatment of spinal disorders. With that growth came a renaissance of innovation, par-
ticularly with the evolution of spinal instrumentation and fixation techniques. In this article, the authors capture some of
the key milestones that have led to the field of spine surgery today, with an emphasis on the historical advances related
to instrumentation, navigation, minimally invasive surgery, robotics, and neurosurgical training.
https://thejns.org/doi/abs/10.3171/2019.9.SPINE181362
KEYWORDS fixation; fusion; history; innovation; instrumentation; navigation; plates; rods; robotics; screws; surgical
technique

B
efore spinal fixation techniques were developed in a single review. We hope to outline the enormous strides
the early 20th century, the treatment of unstable le- that have been realized in this relatively short period, so
sions centered on immobilization using bed rest, we can appreciate the many accomplishments that enable
traction, splinting, and bracing. Surgical morbidity related us to provide high-quality spinal treatments today.
to an absence of antiseptic technique, lack of thermocau-
tery, and lack of appropriate anesthesia made nonsurgical Thoracolumbar Fixation
treatments favorable. Early traction and immobilization
racks, which date back to Hippocrates around 400 bce,51 One of the earliest successful internal fixation tech-
were the mainstay of treatment until the 20th century. De- niques was developed by Hadra, who sought to stabilize
spite little development in spine surgery techniques over cervical fractures caused by Pott’s disease.33 In 1891,
the centuries, anatomical knowledge and an understand- Hadra treated a cervical fracture by fastening a silver wire
ing of pathophysiology continued to grow.29 After the con- loop around the spinous processes in a figure-eight forma-
tributions of Semmelweis and Lister toward antisepsis in tion. Further development by Hadra and Lang improved
the operating theater at the end of the 19th century, spine these wiring techniques and laid the groundwork for in-
surgery attempts resurged with much greater success. This ternal stabilization, which improved recovery times and
resurgence included the first laminectomies performed outcomes compared to those with external immobiliza-
by Macewen in 1886,48 spinal tumor resection performed tion alone. This technique was independently advanced by
by Horsley in 1887,74 and anterior column debridement Albee2 and Hibbs40 in 1911 with the introduction of early
for spinal cord decompression of tuberculous spondylitis posterolateral arthrodesis. Hibbs’s technique, which ulti-
through an anterolateral extrapleural approach performed mately became the predominant method of fusion for the
by Ménard in 1895.53 subsequent 5 decades, involved using decorticated spinous
In this historical review, we highlight some of the con- process autografts folded downward to contact the caudal
tributions to modern spine surgery with an emphasis on process while simultaneously decorticating the articular
the development of spinal instrumentation and associated surfaces, resulting in interlaminar fusion. In 1923, autop-
techniques that followed these great accomplishments sies performed on 9 persons who had received a Hibbs fu-
(Fig. 1). While many of the great strides in the field are de- sion before death revealed solid fusions, thereby verifying
scribed here, hundreds of small contributions in each area the successful, lasting nature of the procedure.8
helped to drive the field forward and cannot be captured in Wiring techniques remained the mainstay of posterior

ABBREVIATIONS ACP = anterior cervical plating; CT = computed tomography; FDA = US Food and Drug Administration.
SUBMITTED August 5, 2019. ACCEPTED September 3, 2019.
INCLUDE WHEN CITING DOI: 10.3171/2019.9.SPINE181362.

©AANS 2019, except where prohibited by US copyright law J Neurosurg Spine Volume 31 • December 2019 775

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Walker et al.

FIG. 1. Timeline highlighting major historical contributions to the field of spine surgery. MIS = minimally invasive surgery;
PLIF = posterior lumbar interbody fusion; TLIF = transforaminal interbody fusion.

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FIG. 2. Illustrations of major contributory fixation technologies: Harrington37 rod system (A), Luque47 system for the thoracolumbar
spine (B), and lateral mass plating system originally described by Roy-Camille (C).62 Figures 2A–C are used with permission from
Barrow Neurological Institute, Phoenix, Arizona. Figure 2A previously appeared in Maric Z, Dickman CA: Instrumentation for posteri-
or fixation of the thoracic and lumbar spine. BNI Quarterly 10:18–26, 1994. Figure 2B previously appeared in Vardiman AB, Sonntag
VKH, Dickman CA: Thoracic spine instrumentation. Techniques in Neurosurgery 1:240–256, 1996. Figure 2C previously appeared
in Dickman CA, Sonntag VKH, Marcotte PJ: Techniques of screw fixation of the cervical spine. BNI Quarterly 8:9–26, 1992.

spinal fixation for many years. In 1943, Tourney76 first de- romuscular scoliosis (specifically paralytic scoliosis from
scribed a technique of adding facet screws to the fusion poliomyelitis), Harrington37 designed a spinal instrumen-
construct to hasten recovery and obviate the need for long- tation system using steel rods attached to hooks to cor-
term bracing, casting, and immobilization. This technique rect the deformity through compression and distraction.
was modified and expanded by King,46 who presented his Over the course of the next decade, he made iterative im-
work in 1948. Importantly, these pioneers astutely real- provements to the system, and its applications expanded
ized that fixation did not replace the need for fusion and to include other types of scoliosis as well as stabilization
that arthrodesis remained the most important portion of for spinal trauma and other etiologies (Fig. 2).37,38,47,62 Im-
the procedure. This focus propelled the first investigations portantly, Boucher11 was credited with placing the first
into interbody arthrodesis with the introduction of poste- pedicle screw in 1959, with Harrington and Tullos39 later
rior lumbar interbody placement by Briggs and Milligan improving upon the technique, which had previously been
in 1944.12 thought to be too dangerous.
In the late 1950s, challenged by the need to treat neu- The rapid evolution of posterior instrumentation of the

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thoracolumbar spine then ensued (Fig. 2). Magerl50 and lantoaxial instability was treated with immobilization and
Dick and colleagues22,23 each made advances with fixation was largely considered inoperable until the early 1900s.
systems intended to improve biomechanical purchase and In 1910, Mixter and Osgood54 first described using silk
reduce the number of healthy segments needed for fusion sutures to fixate atlantoaxial instability with reduction ac-
constructs.83 In 1982, Steffee73 began designing a segmen- complished via manual pressure on the pharynx and trac-
tal spine plate fixation system, which brought with it the tion on the posterior arch of C1. Subsequently, Foerster27
first notion of variable screw placement. In addition to first described attempts to achieve atlantoaxial fusion
these major design improvements in fixation systems, two using fibular grafts in 1927. Various advances in wiring
major long-segment systems were developed to improve techniques for obtaining fusion followed. Gallie described
upon Harrington’s system (Fig. 2A). In 1986, Luque47 the first well-established technique of a bone graft wired
introduced his wire-and-rod fixation system, which was between the posterior arches of C1 and C2, which he pre-
intended to be a posterior fixation that better maintained sented to the American Academy of Orthopaedic Sur-
sagittal contouring (Fig. 2B). Likewise, in 1987, Cotrel geons in the early 1950s (C. Tator, personal communica-
and Dubousset20 designed a pedicular fixation system that tion, 1992; Fig. 3A). Two decades later, Brooks13 attempted
used bent rods that followed the natural curvature of the to improve shortcomings in the rotational restriction of
spine. These rods could attach to vertebral hooks or ped- the Gallie construct by using two individually compressed
icle screws and could be used for scoliosis correction and notched bone grafts, one in each interlaminar space (Fig.
universally for other applications. Despite the significant 3B).13 At our institution, the Sonntag-Dickman modified
shortcomings of both of these systems, spinal deformity approach,25 which was first described in 1989,24 used an
correction continued to improve and pushed forward in- interspinous iliac crest method similar to Gallie’s, requir-
novations yielding successive iterative enhancements. ing sublaminar wires only under the arch of one level at
However, the growth of spinal instrumentation hit an C1 (Fig. 3C).25
impasse in the 1990s when multiple class-action lawsuits Around the same time, Magerl31 described placement
were brought against manufacturers, surgeons, and the of a transarticular screw for stabilization of the C1–2 seg-
governing societies (the American Association of Neuro- ments that did not require the dorsal elements to be in-
logical Surgeons, the North American Spine Society, and tact (although the construct was often later complemented
the American Academy of Orthopaedic Surgeons) for the with a Sonntag-Dickman construct to improve the chances
use of pedicle screws. These lawsuits came after the US of fusion). The placement of this transarticular screw pro-
Food and Drug Administration (FDA) asked manufactur- vided greater prevention of lateral bending and axial rota-
ers to stop the promotion of bone screws as pedicle screws tional movements than posterior bone constructs alone.56
because of the limited amount of data regarding their ef- In 1994, Goel28 described using a modified plate and plate
ficacy. An outcry from the media resulted, and the indus- fixation of the lateral masses of C1 and C2, thereby allow-
try of spinal implants was criminalized, along with the ing for direct reduction of C1 subluxation and circumvent-
surgeons placing the screws. A historical cohort study of ing cases in which subarticular screw placement would be
pedicle screw fixation in thoracic, lumbar, and sacral spi- precluded by aberrant vertebral artery anatomy. Harms
nal fusion82 was soon performed by both orthopedic and and Melcher35 enhanced this method by using screws in
neurological surgeons from the defending societies, which the lateral masses of C1 and pedicles of C2 connected
showed that the use of pedicle screws improved fusion by two rods (Fig. 3D). It should also be noted that direct
rates in degenerative spondylolisthesis from 70% to 90%. screw fixation techniques of odontoid fractures were de-
Nevertheless, only after an enormous amount of debating veloped around this same time; numerous series had been
and discussion from both the companies and surgeons did published by 1990, and the original description was cred-
the FDA Advisory Panel on Orthopaedic and Rehabili- ited to Böhler’s 1981 publication.9
tative Devices recommend to the FDA that the implants Similar techniques were adapted for cervical occipital
be changed from class III to class II. Still, no action was constructs as well, with wiring techniques providing the
forthcoming. It was 4 years later, in 1998, when the FDA majority of occipital fixation. In 1993, Sonntag72 described
ultimately reclassified pedicle screws.71 the use of a contoured Steinmann pin bent into an inverted
After this reclassification, an enormous boom occurred U-shape with which occipital wires could be rigidly fix-
in the industry, leading to modern-day implant systems. ated to the cervical spine as far caudally as required, and
These systems include improvements in design related to bone graft could be harnessed for fusion (Fig. 3E).72 This
screw and rod materials, threading, cap technology, angle procedure gave way to later techniques that used occipital
preference, and reduction tools. Advances in biomechan- plating63,70 or condylar screws.78
ics research have paralleled this growth, thereby providing In the subaxial cervical spine, multiple subaxial wir-
a more objective understanding of the instrumentation’s ing techniques were employed, including interspinous,
strengths and weaknesses. sublaminar, and facet techniques. The Roy-Camille plate
improved on these techniques in 1983 and allowed for
the absence of a dorsal boney arch by introducing lateral
Cervical Fixation mass screws.62 Lateral mass screws improved fixation and
Stabilization methods for the cervical spine warrant allowed patients to heal without halo orthosis (Fig. 2C).
special attention, particularly regarding methods focused Several years later, the Magerl hook-plate system30 was
on treating atlantoaxial instability and injuries. Similar to described, which improved upon lateral mass fixation by
the history of fixation for thoracolumbar conditions, at- suggesting a slightly different screw trajectory to reduce

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FIG. 3. Illustrations of the atlantoaxial fixation techniques described by Gallie (C. Tator, personal communication, 1992, A), Brooks
(B),13 Sonntag (C),25 and Harms (D).35 Early occipital cervical fixation was performed using wire constructs attached to a U-shaped
Steinmann pin (E).72 Figures 3A–C and E are used with permission from Barrow Neurological Institute, Phoenix, Arizona. Figures
3A and C previously appeared in Sonntag VKH, Dickman CA: Treatment of upper cervical spine injuries, in Rea GL, Miller CA
(eds): Spinal Trauma: Current Evaluation and Management. Park Ridge, IL: AANS Publications, 1993, pp 25–74. Figure 3B
previously appeared in Sonntag VKH, Dickman CA: Occipitocervical instrumentation, in Hitchon PW, Traynelis VC, Rengachary
S (eds): Techniques in Spinal Fusion and Stabilization. New York: Thieme Medical Publishers, 1993, pp 243–272. Figure 3E
previously appeared in Dickman CA, Apostolides PJ, Karahalios DG: Surgical techniques for upper cervical spine decompression
and stabilization. Clin Neurosurg 44:137–160, 1997. Figure 3D is reprinted from Operative Techniques in Neurosurgery, Vol 7, Gon-
zalez LF, Theodore N, Dickman CA, Sonntag VKH, Occipitoatlantal and atlantoaxial dislocation, pp 16–21, 2004, with permission
from Elsevier. https://www.sciencedirect.com/journal/operative-techniques-in-neurosurgery.

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FIG. 4. Early anterior cervical fixation required bicortical screw fixation (A) but improved with the development of fixed/variable and
locking screws, as shown here with the Atlantis plate (B). Multiple cervical plate designs have advanced plating technology, includ-
ing the Caspar (C, Aesculap), Synthes CSLP (D, DePuy Synthes), Orion (E, Medtronic Sofamor Danek), Codman (F, Johnson &
Johnson), Atlantis (G, Medtronic Sofamor Danek), and ABC Trapezoidal™ (H, Aesculap) plates. Figures 4A and B are used with
permission from Barrow Neurological Institute, Phoenix, Arizona. Figure 4A previously appeared in Dickman CA, Sonntag VKH,
Marcotte PJ: Techniques of screw fixation of the cervical spine. BNI Quarterly 8:9–26, 1992. Figure 4B previously appeared in
Baskin JJ, Vishteh AG, Dickman CA, Sonntag VKH: Techniques of anterior cervical plating. Operat Tech Neurosurg 1:90–102,
1998. Figures 4C–G are reprinted from Operative Techniques in Neurosurgery, Vol 1, Baskin JJ, Vishteh AG, Dickman CA,
Sonntag VKH, Techniques of anterior cervical plating, pp 90–102, 1998, with permission from Elsevier. https://www.sciencedirect.
com/journal/operative-techniques-in-neurosurgery. Figure 4H is used with permission from Aesculap.

the risk of neural and vascular injury. Continued improve- use occurred in 1970 by Orozco and Llovet,59 and Cas-
ments in these screw techniques3,4 and screw-rod fixation par popularized its use in the 1980s.16 These early ACPs
systems then followed.43 were unrestricted back-out plates and required bicortical
Early attempts at anterior cervical fusion date back screw purchase, a stipulation that increased the risk of spi-
to the 1950s, with the first description by Bailey and nal cord injury and screw pullout (Fig. 4A). In response
Badgley in 19607 and technical improvements in the non- to each ACP shortcoming, a wave of designs emerged,
instrumented technique by Smith and Robinson68 and with the refinement of constrained and semi-constrained
Cloward.17,18 Anterior cervical plating (ACP) transformed screws, screw locking mechanisms, and hybrid systems al-
the field of cervical fusion, and an entire article focused lowing for angled or variable trajectories, grooves for drill
on this topic alone is warranted.34,55 The first reported taps, and prebent lordotic curvature (Fig. 4B–H). Trailing
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ment during the past century has been related to imag-

ing improvements, and this too applies to spinal disease.
Early studies of myelography building off the foundational
roentgenography date back to the 1920s and 1930s with
the injection of lipid-based contrast agents.67,79 After the
invention of computed tomography (CT) in 1972 and mag-
netic resonance imaging in 1974, enhanced evaluation of
the spine followed.
While these advances in imaging science applied to
both diagnosis and evaluation of surgical disorders, they
also led directly to the adoption of image guidance for
intraoperative use. One of the earliest reported studies
in spine surgery demonstrating the use of fluoroscopic
guidance was by Selman, Spetzler, and Brown66 in 1981,
in which they described using fluoroscopy to assess the
extent of resection during 4 cases of transoral odontoidec-
tomy. The similar use of biplanar fluoroscopy for odontoid
screw placement followed.10 In 1996, Odgers et al.58 first
published their study of pedicle screws placed using in-
traoperative lateral fluoroscopy, thereby creating the first
discussions of screw navigation.
The introduction of frameless stereotaxy using surface
reference markers was shown to be beneficial for intracra-
nial surgery, but the technique was first applied in 1995 by
Kalfas et al.44 for the use of pedicle screw fixation. In this
early application, a preoperative CT study was registered
to spinal anatomy interfaced with a sonic digitizer device.
This technique was followed in the 2000s by intraopera-
tive CT navigation, which improved on limitations of pre-
FIG. 5. Cervical arthroplasty designs: Prestige (A, Medtronic Sofamor
Danek), Bryan (B, Medtronic Sofamor Danek), ProDisc-C (C, DePuy
operative CT guidance.32,42 Adaptations of the navigation
Synthes), CerviCore (D, Stryker Spine), and Mobi-C (E, Zimmer Biomet). software, instrumentation, reference arrays, and intraop-
Figures 5A–D are reproduced from Baaj et al: Neurosurg Focus erative CT scanners continue to result in improvements
27(3):E10, 2009. Published with permission. Figure 5E is used with per- in spine surgery. As a result, surgeons have been able to
mission from Zimmer Biomet. achieve extremely high pedicle screw accuracy rates using
modern navigation.
In 2000, the FDA cleared the da Vinci surgical robot
behind ACP technology has been that of the interbody de- (Intuitive Surgical) for general laparoscopic surgery appli-
sign, with the emergence of polyetheretherketone, metal cations. This approval paved the way for the first robotic
alloys, and, most recently, nanotextured surfaces intended spinal navigation system, SpineAssist (Mazor Robotics
to allow graft-bone interfacing. Ltd.), in 2004. Since then, SpineAssist has been replaced
Cervical arthroplasty, too, has found its unique evolu- by its successors, the Renaissance Guidance System
tion more recently. While Fernström is credited with plac- (Mazor Robotics) and the Mazor X (Medtronic), as well as
ing the first artificial cervical device in 196626—a stain- its competitor the ExcelsiusGPS (Fig. 6A; Globus Medical
less steel ball-bearing prosthesis used to treat headaches Inc.). While the field of surgical robotics appears to be in
and cervicobrachialgia—the device suffered from failures its infancy, studies continue to demonstrate promise and
in design. Repeat attempts at cervical arthroplasty were suggest that robotics in spinal navigation will continue to
made by Cummins in 1989 in Bristol, UK, again with play a key role in the future.75
discouraging complications of hardware failure and per-
sistent dysphagia.77 Widespread use was ignited after the Minimally Invasive Spine Surgery
completion of successful randomized trials of the rede-
signed Cummins-Bristol disc, now called the “Prestige Attempts to minimize the patient morbidity associated
Disc,” and a competing design called the “ProDisc-C,” with surgery of the cervical, thoracic, and lumbar spine
leading to FDA approval of both devices in 2007.6 Since have been extensive. Early attempts to treat lumbar disc
that time, additional designs and material advancements herniation centered on methods that removed central disc
have been made to the technology alongside additive ex- content, reduced intradiscal pressure, and helped decrease
perimental data supporting the viability and value of mo- neural compression. Chemonucleolysis using chymopapa-
tion preservation in appropriate clinical settings (Fig. 5). in, first used in 1964 by Smith,69 and percutaneous laser-
assisted discectomy, first used in 1984 by Ascher and Hep-
pner, 5 are two examples of such methods. After reducing
Surgical Technology in Spine Surgery neural compression, direct visualization of the disc was
Arguably the largest driver of neurosurgical advance- then performed, with Hijikata41 first describing percutane-
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FIG. 6. Minimally invasive spinal technology: robotic ExcelsiusGPS (A, Globus Medical Inc.) surgical arm for placing guided
pedicle screws, METRx tube (B, Medtronic Sofamor Danek) for minimally invasive tubular microdiscectomy, and lateral interbody
arthrodesis (C). Figure 6A is used with permission from Globus Medical. Figure 6B is used with permission from Medtronic. Figure
6C is used with permission from Zimmer Biomet.

ous nucleotomy through a posterolateral approach. Kam- percutaneous pedicle screw fixation by Wiesner et al. in
bin and Gellman45 followed suit by performing fluoroscop- 200080 with microendoscopic lumbar techniques to de-
ically guided percutaneous discectomies in 1983. rive the minimally invasive transforaminal interbody ap-
However, these techniques failed to address sequestered proach, as described by Schwender et al.64
and migrated disc fragments. This issue led to directly vi- Minimally invasive anterior and anterolateral ap-
sualized discectomies performed under the microscope, as proaches to the thoracic and lumbar spine followed their
described by Yasargil81 and Caspar.15 Thus, a microendo- unique histories. The earliest reports of anterior interbody
scopic tubular system was introduced in 1997 (ultimately fusion date back to 1933, when Burns first treated patients
improved upon to form the METRx system [Medtronic with spondylolisthesis.14 With the growing prominence of
Sofamor Danek; Fig. 6B]) and became popular for per- general, urological, and gynecological laparoscopic surgi-
forming discectomies, foraminotomies, and laminecto- cal applications in the 1980s, Obenchain57 described the
mies.61 Building off Scoville’s technique (first described in first anterior lumbar discectomy using laparoscopy in
1976)65 of posterior cervical discectomies, Adamson used 1991. At roughly the same time, Fessler first described the
the same tubular techniques to perform microendoscop- endoscopic approach to the retroperitoneal lumbar spine
ic cervical foraminotomies.1 Similarly, in 2005, Foley’s in 1992 (and his approach to fusion via this method in
group combined early descriptions of the transforaminal 1997: “Endoscopically assisted retroperitoneal fusion,”
interbody placement by Harms and Rolinger in 198236 and presented at the AANS Annual Meeting held in Denver,
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CO), while video-assisted thoracoscopic surgery was ini- understanding and treatment of spinal deformity, particu-
tially reported by Mack and colleagues in 1993.49 In the larly in adults, continues to expand. The inclusion in the
years that followed, mini-open retractor–based approach- general neurosurgical residency curriculum of spinopelvic
es took over following Mayer’s description of a minimally parameters, sagittal alignment, and scoliosis reflects these
invasive oblique retroperitoneal access to the lumbar spine changes as well. Moreover, it is now estimated that, of all
in 199752 and Ozgur and colleagues’ description of the lat- neurosurgical operations, 77% are performed for spinal
eral transpsoas technique in 2006 (Fig. 6C).60 Combined cases, and this percentage is growing as of 2013.19
with advances in navigation and robotics, novel biomateri-
als, and advanced biologics, the application of these tech- Conclusions
niques has broadened applications to increasingly complex
pathologies, including spinal deformity and scoliosis; tho- The field of spine surgery has undergone one of the
racic disc disease; and corpectomies for trauma, tumor, greatest transformations in medicine over the past 100
and infectious etiologies. years. In that period, the most significant advancement has
come with the evolution of spinal instrumentation and fu-
sion in the past 3 decades. In this article, we have been able
Surgical Education and Fellowship to capture only certain components of many monumental
Neurosurgical involvement in spinal disease dates back milestones, each of which likely required the dedication of
to Cushing’s first attempt at intramedullary spinal tumor many unnamed surgeons, scientists, engineers, and entre-
resection in 1905.21 Major contributions by neurosurgeons, preneurs. Both neurosurgical and orthopedic contributions
such as Stockey, Semmes, Murphy, Spurling, and Scoville, have been tremendous, with continued daily innovation,
in the 1930s, 1940s, and 1950s helped to drive the treat- particularly in the areas of navigation, robotics, materi-
ment of spinal disease forward. However, neurosurgical als science, and spinal biomechanics. These contributions
participation in spinal fusion remained limited until the have allowed for safer, more efficacious, and more efficient
late 1980s, when a growing number of neurosurgeons methods of treatment, improving outcomes and quality of
started to take on the early cervical fixation techniques life for patients. Looking at the history of spine surgery
described above. But only one neurosurgical spine fellow- and its incredible recent journey provides excitement for
ship, Sandy Larson’s in Wisconsin, existed at that time. continued progress in the future.
That changed when the Accreditation Council for Gradu-
ate Medical Education first started to recognize orthope- Acknowledgments
dic spine fellowships for accreditation in the late 1980s. We thank the staff of the Neuroscience Publications office
In response to the fear that neurosurgical education would at Barrow Neurological Institute for assistance with manuscript
lose its role in spine surgery and training, a Spine Task preparation.
Force, led by David Kelly, was put into place to develop
guidelines for the spinal surgery training of neurosurgi- References
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J Biol Med 11:433–435, 1939 Disclosures
68. Smith GW, Robinson RA: The treatment of certain cervical- Dr. Sonntag receives royalties from Medtronic and Danali; Dr.
spine disorders by anterior removal of the intervertebral disc Chang receives royalties from and is a consultant for Globus and
and interbody fusion. J Bone Joint Surg Am 40-A:607–624, Zimmer.
1958
69. Smith L: Enzyme dissolution of the nucleus pulposus in hu- Author Contributions
mans. JAMA 187:137–140, 1964
70. Smith MD, Anderson P, Grady MS: Occipitocervical ar- Conception and design: Sonntag. Acquisition of data: Sonntag,
throdesis using contoured plate fixation. An early report on a Walker. Analysis and interpretation of data: Sonntag, Walker.
versatile fixation technique. Spine (Phila Pa 1976) 18:1984– Drafting the article: Walker. Critically revising the article:
1990, 1993 Sonntag, Kakarla, Chang. Reviewed submitted version of manu-
71. Sonntag VK: The development of spinal neurosurgery: a his- script: all authors. Study supervision: Sonntag.
torical perspective. Neurosurgery 60:587–588, 2007
72. Sonntag VK, Dickman CA: Craniocervical stabilization. Correspondence
Clin Neurosurg 40:243–272, 1993 Volker K. H. Sonntag: c/o Neuroscience Publications, Barrow
73. Steffee AD, Biscup RS, Sitkowski DJ: Segmental spine plates Neurological Institute, St. Joseph’s Hospital and Medical Center,
with pedicle screw fixation. A new internal fixation device Phoenix, AZ. [email protected].
for disorders of the lumbar and thoracolumbar spine. Clin
Orthop Relat Res (203):45–53, 1986

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