JBJS Classics: Cervical Discectomy and Interbody Fusion
Each month during the coming year, OrthoBuzz will bring you a current commentary on a “classic” article from The Journal of Bone & Joint Surgery. These articles have been selected by the Editor-in-Chief and Deputy Editors of The Journal because of their long-standing significance to the orthopaedic community and the many citations they receive in the literature. Our OrthoBuzz commentators will highlight the impact that these JBJS articles have had on the practice of orthopaedics. Please feel free to join the conversation about these classics by clicking on the “Leave a Comment” button in the box to the left.
It is rare that an article published more than 50 years ago continues to have an impact on clinical practice today. But that is the case with “The Treatment of Certain Cervical-Spine Disorders by Anterior Removal of the Intervertebral Disc and Interbody Fusion.” What make this article so unique are the details that Drs. George Smith and Robert Robinson put into describing the procedure and the careful follow-up of their early experience with this technique.
I have had a copy of this article in my files since I was a resident at Yale, training with Wayne Southwick, who had trained with Dr. Robinson at the time this approach to the cervical spine was developed. The two key contributors to anterior cervical spine surgery back in the 1950s were Dr. Robinson and the neurosurgeon Dr. Ralph Cloward.
Dr. Robinson’s technique has the support of biomechanical principles, which makes this particular approach and bone-graft fusion construct inherently stable; hence, its continued use to this very day. However, back in the ‘50s, and even when I trained in the 1970s, hardware to stabilize the spine following discectomy was not available in the US.
The approach that these authors described is very versatile and is utilized for all sorts of anterior procedures, including removal of intervertebral discs, arthrodesis, and vertebrectomy, and it allows for doing multiple-level procedures. The technique I use today is the same one that Dr. Southwick taught me and that he learned directly from Dr. Robinson.
Dr. Robinson has had a major impact on cervical spine surgery, and it was estimated that at one time 33% to 50% of members of the Cervical Spine Research Society were trained by him, by one of his residents or fellows, or by one of their residents or fellows—Dr. Robinson’s “offspring.”
I believe this technique will continue to stand the test of time, as it has during the past half century, and will have a major influence on spine surgery well into the future.
Charles Clark, MD
JBJS Deputy Editor for Adult Reconstruction and Spine