TY - JOUR
T1 - No clinical puzzles more interesting
T2 - Harvey cushing and spinal trauma, the Johns Hopkins Hospital 1896-1912
AU - Dasenbrock, Hormuzdiyar H.
AU - Pendleton, Courtney
AU - Cohen-Gadol, Aaron A.
AU - Witham, Timothy F.
AU - Gokaslan, Ziya L.
AU - Quinones-Hinojosa, Alfredo
AU - Bydon, Ali
PY - 2011/2
Y1 - 2011/2
N2 - ABSTRACT: Although Harvey Cushing played a central role in the establishment of neurosurgery in the United States, his work on the spine remains largely unknown. This article is not only the first time that Cushing's spinal cases while he was at Johns Hopkins have been reported, but also the first time his management of spinal trauma has been described. We report on 12 patients that Cushing treated from 1898 to 1911 who have never been reported before, including blunt and penetrating injuries, complete and incomplete spinal cord lesions, and both immediate and delayed presentations. Cushing performed laminectomies within 24 hours on patients with immediate presentations- both complete and incomplete spinal cord lesions. Among those with delayed presentations, Cushing did laminectomies on patients with incomplete spinal cord injuries. By the end of his tenure at Hopkins, Cushing advocated nonoperative treatment for all patients with complete spinal cord lesions. Four patients died while an inpatient, with meningitis and cystitis leading to the death of 1 and 3 patients, respectively. Cystitis was treated with intravesicular irrigation; an indwelling catheter was placed by a suprapubic cystostomy in four. Cushing was one of the first to report the use of x-ray in a spine patient, in a case that may have been one factor leading to his interest in the nervous system; Cushing also routinely obtained radiographs in those with spinal trauma. These cases illustrate Cushing's dedication to and rapport with his patients, even in the face of a dismal prognosis.
AB - ABSTRACT: Although Harvey Cushing played a central role in the establishment of neurosurgery in the United States, his work on the spine remains largely unknown. This article is not only the first time that Cushing's spinal cases while he was at Johns Hopkins have been reported, but also the first time his management of spinal trauma has been described. We report on 12 patients that Cushing treated from 1898 to 1911 who have never been reported before, including blunt and penetrating injuries, complete and incomplete spinal cord lesions, and both immediate and delayed presentations. Cushing performed laminectomies within 24 hours on patients with immediate presentations- both complete and incomplete spinal cord lesions. Among those with delayed presentations, Cushing did laminectomies on patients with incomplete spinal cord injuries. By the end of his tenure at Hopkins, Cushing advocated nonoperative treatment for all patients with complete spinal cord lesions. Four patients died while an inpatient, with meningitis and cystitis leading to the death of 1 and 3 patients, respectively. Cystitis was treated with intravesicular irrigation; an indwelling catheter was placed by a suprapubic cystostomy in four. Cushing was one of the first to report the use of x-ray in a spine patient, in a case that may have been one factor leading to his interest in the nervous system; Cushing also routinely obtained radiographs in those with spinal trauma. These cases illustrate Cushing's dedication to and rapport with his patients, even in the face of a dismal prognosis.
KW - Harvey Cushing
KW - History of neurosurgery
KW - Spinal trauma
UR - http://www.scopus.com/inward/record.url?scp=79951670261&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79951670261&partnerID=8YFLogxK
U2 - 10.1227/NEU.0b013e318201be60
DO - 10.1227/NEU.0b013e318201be60
M3 - Article
C2 - 21135734
AN - SCOPUS:79951670261
SN - 0148-396X
VL - 68
SP - 420
EP - 430
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -