Surgeon-anatomist to robotic technician? The evolving role of the surgeon over three centuries.

In the 18th century, anatomy was the principal science underlying surgical practice. Over the next three centuries, the scientific basis of surgery changed dramatically. Morbid anatomy led to the understanding of organ-based pathologies that allowed surgeons to remove, reconstruct and in some cases replace internal organs.

Why is William Sharp's name forgotten when his novel method for treating fractures of the Ankle is still used today?

In 1837 Guillaume von Dupuytren (1777-1835) wrote that the innovative method of reducing an ankle fracture by relaxing the calf muscles was due to both William Sharp (1729-1810) and Percivall Pott (1714-1788). While history records the many surgical achievements of Percivall Pott, little is known of William Sharp's contribution. He is probably best known as one of a remarkable family portrayed by Johan Zoffany (1733-1810) and exhibited at the Royal Academy in 1781.

The enigma of Sir William Robert Wills Wilde (1815-1876).

William Wilde, father of Oscar Wilde, made a significant contribution to ophthalmology and otology. Qualified as a surgeon. educated in statistics and showing sympathy for the Irish population, Wilde was appointed a Commissioner for the 1851 Census, which covered the time of the Irish Famine (1845-1852).

Person or system - What leads to surgical advances?

To understand the relationship between standardisation and originality in surgery, the contributions of three surgeons in the 20th century are analysed. The individual Arbuthnot Lane, the collectivist Robert Jones and the scientist Alexis Carrel changed the practice of orthopaedic surgery. It is argued that the factors influencing innovation are not binary but multifactorial and that advances in surgery occur when individual freedom is permitted within a system.

Color Doppler ultrasonography of lumbar artery blood flow in patients with low back pain.

Study Design: Prospective, clinical, noninvasive imaging study.

Objective: To quantify normal lumbar artery hemodynamics and develop a reference range and lumbar artery hemodynamics in patients with low back pain.

Summary Of Background Data: Blood supply to the lumbar spinal tissues, intraosseous capillary circulation, and avascular intervertebral discs derives directly from the lumbar arteries.

The impact of intermittent retraction on paraspinal muscle function during lumbar surgery.

Study Design: Prospective cohort study.

Objective: To study the effect of surgical retraction on paraspinal muscle function and investigate the effect of intermittent muscle retraction.

Summary Of Background Data: Paraspinal muscle retraction leads to increased intramuscular pressure with a reduction in local blood flow resulting in ischemic damage.

The effect of different insertion points on the security of pedicle screw fixation in bovine vertebrae.

Study Design: Cyclic loading of pedicle screws inserted into bovine vertebrae was applied and the security of fixation was assessed as a function of the point of insertion of the screws.

Objective: To determine which point of insertion is associated with more secure fixation using 2 commonly selected insertion points.

Summary Of Background Data: The strength of pedicle screw fixation depends on several factors, some of these have been studied.

The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy.

It is not always easy to predict the degree of symptomatic improvement to be expected in a patient undergoing surgery for cervical disc herniation and radiculopathy. Here we investigate whether preoperative electromyography (EMG) can help select those most likely to benefit from intervention. We prospectively evaluated 20 patients whose required operative level was unclear after clinical examination and MRI scan alone.

Colour doppler ultrasound of the lumbar arteries: a novel application and reproducibility study in healthy subjects.

Lumbar arteries are important because they are the main source of blood supply to the lumbar spine structures. However, these vessels and their flow characteristics have received little attention and their role in conditions such as low back pain remains unclear. The present study 1.

Does preoperative hip rehabilitation advice improve recovery and patient satisfaction?

The goal of the current study was to investigate whether preoperative rehabilitation advice reinforced by a patient information booklet can aid recovery after total hip arthroplasty in terms of pain, function, satisfaction, and quality of life. Thirty-five patients awaiting primary total hip arthroplasty were recruited into this study and randomly allocated before admission to receive either the standard pathway of care or the rehabilitation program and booklet. All patients showed increases in function and psychological variables with time.

Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction?

Objective: Preliminary studies have suggested that prolonged retraction of the paraspinal muscle during spinal surgery may produce ischemic damage. We report the continuous measurement of intramuscular pressure (IMP) during decompressive lumbar laminectomy and its relationship to subsequent back pain and disability.

Methods: Twenty patients undergoing two-level decompressive lumbar laminectomy for lumbar canal stenosis were recruited.

MR imaging of degenerative disc disease in the lumbar spine with ultrashort TE pulse sequences.

Objective: The objective of this study was to assess the feasibility of using ultrashort TE (UTE) pulse sequences to image the lumbar spine.

Materials: Pulse sequences of TE=0.08 ms were used to image the lumbar spine in 5 normal subjects and 14 patients with degenerative disease.

Scoliosis in an Orangutan.

Study Design: The first case of scoliosis in an Orangutan spine is reported.

Objectives: To study the nature of scoliosis in the spinal specimen, and to determine the etiologic significance to human idiopathic scoliosis.

Summary Of Background Data: Idiopathic scoliosis has not been observed in primates other than man.

The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery.

Study Design: This was a prospective pilot study examining pre-, intra- and postoperative measures.

Objectives: The aim of the study was to investigate the effect of muscle retractors on the posterior spinal muscles during posterior spinal surgery.

Summary Of Background Data: Previous studies have identified changes in the structure and function of the back extensor mechanism as a result of low back pain.

The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 2: patient expectations and satisfaction.

Study Design: This was a prospective study investigating patient expectations of and satisfaction with the outcome of decompression surgery.

Objectives: To investigate patient expectations of surgery and short- and long-term satisfaction with the outcome of decompression surgery in terms of pain, function, disability, and general health.

Summary Of Background Data: Information is scarce regarding patient-rated expectations of surgery and measures of satisfaction with surgery in terms of specific outcome measures such as pain.

The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 1: the assessment of outcome.

Study Design: This was a prospective study investigating the outcome of decompression surgery using validated measures of outcome.

Objectives: To investigate the outcome of lumbar decompressive surgery in the initial postoperative year period in terms of function, disability, general health, and psychological well-being.

Summary Of Background Data: The majority of studies investigating the outcome of lumbar decompression surgery have been retrospective and have not used validated measures of outcome.

The use of interventional open MRI to assess the kinematics of the lumbar spine in patients with spondylolisthesis.

Study Design: Open interventional MRI techniques were used to investigate the intervertebral mobility of the lumbar spine in subjects with isthmic and degenerative spondylolisthesis. The findings were compared with those in a published database of subjects with no history of low back pain.

Objective: To investigate patterns of intervertebral mobility in subjects with spondylolisthesis to determine the level of spinal instability in this population.

Nerve fibers in lumbar spine structures and injured spinal roots express the sensory neuron-specific sodium channels SNS/PN3 and NaN/SNS2.

Study Design: This prospective study examined the innervation of lumbar spine in tissues from patients with lower back pain and spine nerve roots from patients with traumatic brachial plexus injuries.

Objectives: To demonstrate the presence of nerve fibers in lumbar spine structures and spine nerve roots, and to determine whether they express the sensory neuron-specific sodium channels SNS/PN3 and NaN/SNS2.

Summary Of Background Data: The anatomic and molecular basis of low back pain and sciatica is poorly understood.