“Fulfilling the chief of his duties as a physician”: Harvey Cushing, selective dorsal rhizotomy and elective spine surgery for quality of life

Historical vignette

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At the beginning of the 20th century, the development of safer anesthesia, antiseptic techniques, and meticulous surgical dissection led to a substantial decrease in operative risk. In turn, the scope of surgery expanded to include elective procedures performed with the intention of improving the quality of life of patients. Between 1908 and 1912, Harvey Cushing performed 3 dorsal rhizotomies to improve the quality of life of 3 patients with debilitating neuralgia: a 54-year-old man with “lightning” radicular pain from tabes dorsalis, a 12-year-old boy cutaneous hyperesthesia and spasticity in his hemiplegic arm, and a 61-year-old man with postamputation neuropathic pain. Symptomatic improvement was seen postoperatively in the first 2 cases, although the third patient continued to have severe pain. Cushing also removed a prominent spinous process from each of 2 patients with debilitating headaches; both patients, however, experienced only minimal postoperative improvement. These cases, which have not been previously published, highlight Cushing's views on the role of surgery and illustrate the broader movement that occurred in surgery at the time, whereby elective procedures for quality of life became performed and accepted.

Article Information

Address correspondence to: Ali Bydon, M.D., Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 5-109, Baltimore, Maryland 21287. email: abydon1@jhmi.edu.

Please include this information when citing this paper: published online January 21, 2011; DOI: 10.3171/2010.10.SPINE10152.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 2. This 12-year-old boy with right spastic hemiplegia presented with intense hyperesthesia in his spastic and contracted right arm. Cushing performed a C3–7 laminectomy with division of 4 posterior roots. His drawings depict the intraoperative approach after exposure (left), with the spinous processes of C-2 to T-1 labeled, as well as after the laminectomy (right), with the spinous processes remaining on C-2 and T-1, but having been removed from the other cervical vertebrae. Courtesy of the Alan Chesney Medical Archives of the Johns Hopkins Hospital.

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    Case 3. This 61-year-old man who had previously undergone a below-the-knee amputation presented with severe neuralgia in his stump. Cushing performed a T10–L2 laminectomy with resection of the posterior nerve roots. His postoperative sketch shows his exposure (right) as well as the spinal cord after he had resected some of the posterior roots (left), with a clear demarcation by an X of where he has drawn a severed root. Courtesy of the Alan Chesney Medical Archives of the Johns Hopkins Hospital.

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