SRS Newsletter
September 2012
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Spinal Surgery at Boston Children's Hospital – 140 Years

Lawrence I. Karlin, MD
Historical Committee Member

Lawrence I. Karlin, MD

The annual reports for the early years of the Children's Hospital have recently been placed on pdf and make fascinating reading. One is struck by the tremendous advances in medicine over a relatively short time. Of special interest to Scoliosis Research Society (SRS) members is the dramatic change in the field of spinal surgery that occurred rather abruptly in the early 1970's.

The hospital began in a converted private home in 1869 and the managers summarized the first year's record "with more than a formal acknowledgment of the divine favor." Apparently the founders maintained the Puritan quality of thrift, for a "distinctive feature of the plan" was that the hospital be "under the charge of voluntary nurses, who are willing to engage in the work for no other recompense than the satisfaction of ministering to the physical and spiritual comfort of the sick and suffering."

The administration seemed quite proud of the fledgling institution, for the "whole air is cheerful and gladsome" and when on the "general ward one almost forgets that he is in the midst of the sick and suffering, as he sees on all sides smiling faces, little hands playing with toys, or turning over pages of illustrated books, and hears cheerful voices prattling merrily, or singling alone or together pleasant songs."

Apparently the founders were well versed in the art of massaging their donors. The reports provide an exhaustive list of individuals and their specific gifts. Thanks went out to Mrs. S. for her $25, but also to Mrs. R. for 1 pair of socks, Miss F. for a jar of quince jam, and, of course, to Miss B. for lint.

During 1870, the first full year of service, there were 83 admissions. The most common orthopaedic condition was morbus coxae, with eight patients. It would appear that the concept of outcomes-based medicine was already established in 1870 with each discharge graded as well relieved, not relieved, or dead. The exact list of criteria for each category was not stated. By 1880 there were 199 admissions of which 69 were diseases of the musculoskeletal system. Two patients had caries of the spine, while 14 were listed as diseases of the spine.

By 1902 admissions were divided by specialty. There was a total of 3269 admissions of which 792 were orthopaedic in nature. The 459 orthopaedic surgical procedures included a single Albee spinal fusion. In 1941 there were 478 orthopaedic procedures: four were spinal fusions.

By 1965, surgery for scoliosis was being performed. This was primarily idiopathic scoliosis with a single case each of post-irradiation and myelomeningocele scoliosis. Of 1209 orthopaedic procedures, 57 were fusions for scoliosis. There were two fusions performed with and 55 without Harrington instrumentation.

Historical Chart

In 1975 there were 1617 orthopaedic procedures which included 200 scoliosis surgeries. Now the types of scoliosis included a wide spectrum: idiopathic, cerebral palsy, myelomeningocele, congenital, sacral agenesis, and myopathy. As noted in the table the entire range of surgical interventions were employed. In 2010 there were 339 surgeries for scoliosis and 3970 in-patient orthopaedic procedures.

It is clear that a sea change in the treatment of spinal deformity occurred between 1965 and 1975. The development of spinal instrumentation takes some credit, but Harrington began his work in 1954 and published it in 1962. Yet three years later only two instrumented procedures were performed at Children's Hospital, Boston. The Scoliosis Research Society first met in 1966 and this format undoubtedly helped disseminate knowledge.

It takes an individual open to new ideas to implement them. The deciding element responsible for the dramatic change in spinal surgery at Children's was the arrival in 1971 of John E. Hall, MD, a man with the vision to accept new techniques, the intelligence to appropriately apply them and the inventiveness to improve and expand upon them. It was his dedication to teaching the principles of spinal deformity care that established Children's as a major center for spinal care.

Historical Table

Committee Chair: Behrooz A. Akbarnia, MD Committee Members: Nathan H. Lebwohl, MD, Past Chair; Vishal Sarwahi, MD; David H. Clements, III, MD; Azmi Hamzaoglu, MD; Reinhard D. Zeller, MD; Lawrence I. Karlin, MD.