Biomedical subjects
Publications and source records attributed to R B Cloward.
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An opera singer, who "made her living with her diaphragm", developed a post-traumatic unilateral radiculopathy due to cervical disc lesions, C3 to C6. During one year of severe neck and left arm pain she gradually lost the ability to sing difficult operatic passages which brought an end to her music career. Following a three level anterior cervical decompression and fusion, the neck and arm pain was immediately relieved. One week later her voice and singing ability returned to its full strength and power permitting her to resume her activities as a vocalist. The diagnosis of paresis of the left hemi-diaphragm as part of the cervical disc syndrome was implied by postoperative retrospective inference.
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Based on over 45 years' experience in the surgical treatment of lumbar disc disease, it is recommended that the following operations be eliminated: the simple discectomy, which may cure the sciatica but not the back pain; the "decompressive laminectomy," which leaves the patient with painful instability and nerve-root scarring; and chemonucleolysis, which does not provide permanent relief of either low-back or leg pain. The PLIF technique is the answer to treatment of diseases of the lumbar spine and may be the operation of the future.
Three unusual and rare cases are reported with progressive anterior dislocation of the cervical spine of unknown etiology causing severe myelopathy. Spinal pathology was confined to a single level and at different locations in each case. Narrowing of the spinal canal resulted in three different neurological syndromes, each requiring a different operative approach: one anterior, one posterior, and one both. Two patients made complete functional recovery. One patient died 3 days after operation of aspiration pneumonia.
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Chordoma, a primary malignant neoplasm of the cerebro-spinal axis, is difficult to diagnose and impossible to cure. The only effective treatment is early radical surgical removal, regardless of its size or location. A giant, 65gm tumor arising from the clivus, C1 and C2 vertebrae was successfully removed with low morbidity. The surgical technique is described and compared to other operations with their advantages and disadvantages. A plea is made for surgical removal as the initial treatment for these lesions to prevent fatal intracranial metastasis.
Two cases of vertebral osteomyelitis and discitis in the cervical spine are presented, both having arisen from hematogenous spread to the spine. Bacteriologic diagnosis was established in 1 patient, but the infection had subsided in the other. Both patients were treated with anterior debridement and fusion, and a supplemental posterior wiring and fusion was performed in the second case to reduce kyphotic angulation. In the second case, both the anterior and posterior surgery were performed while the patient was under the same anesthetic. Satisfactory results were achieved in both cases.
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