Properly recorded accounts of spinal cord injury (SCI) and its treatment have existed since ancient times, when medical science was in its infancy.
An Egyptian papyrus roll manuscript from 1700 B.C. was discovered that describes two spinal cord injuries involving fracture or dislocation of the neck vertebrae accompanied by paralysis. This is the earliest record of SCI ever to have been found.
The rolls described the injury as "an ailment not to be treated."
A concept of a treatment for spinal cord injury had progressed little in centuries
Hippocrates of Kos (460-377 B.C.) was a renowned Greek physician who is often referred to as the “Father of Modern Medicine”.
According to him, no treatment options were available for spinal cord injuries with paralysis. And that those patients were destined to die.
However, he did use a primitive form of traction therapy for SCI without paralysis. For this he invented two devices:
• The Hippocratic Ladder: he used this to tie the patients to its rungs and hang them upside-down and let the gravity provide traction.
• The Hippocratic Board: he used this device to immobilize the patients and apply traction using their hands or feet.
Galen of Pergamon (129-200 A.D.), another Greek physician, first stipulated the concept of a ‘central nervous system’ by suggesting that spinal cord was an extension of the brain and was responsible for carrying sensations between brain and the limbs.
Paulus Aegineta (625-690 A.D.) endorsed surgical intervention for SCI to remove the bone fragments as he believed that the fragments were responsible for paralysis.
Records also reflect that Hindu, Arab, and Chinese physicians developed some simplistic forms of traction to treat vertebral conditions. The same principles of traction are still in practice today.
Leonardo Da Vinci (1452-1519 AD) has been credited to be the first person to ever correctly portray the human spine with all of its salient features.
The earliest records of a publication of spinal cord anatomy for educational and academic purposes are found in the anatomy textbook from 1543, written by Andreas Vesalius - a Renaissance physician and teacher(1514-1564 A.D.). He is often referred to as “Father of Modern Human Anatomy”.
Based on his experience and dissection of the spine, he had described and illustrated the spine’s anatomy in complete detail. This enabled the physicians of that era to understand the correct structure of the spine and by extension, the nature of the damage caused by any spinal injury.
The names of the spinal regions that are used today- cervical, thoracic, lumbar, sacral, and coccygeal – were originally given by Vesalius.
The late 19th century brought widespread use of antiseptics and sterilisation into surgical procedures. This enabled surgeons to perform spinal surgeries without significant risk of infection.
The early 20th century equipped medical practitioners with the X-ray. Now surgeons had a way to image the spine and get a more accurate idea of the injury to give a more precise diagnosis and prognosis.
Both of these advancements in medicine made spinal surgery more desirable and relatively easier. Hence, by the middle of the twentieth century, a standard treatment modality was established for SCI: re-positioning the spine and fixing it in place followed by rehabilitation.
In the 1990s, it was found that the use of steroid medication (methylprednisolone) had the potential to reduce inflammation associated with SCI and therefore, reducing damage to the injured nerve cells. This treatment complemented existing treatment options.
The quest for an effective cure for spinal cord injury still continues…
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