The Origins of the Treatment of Traumatic Spinal Injuries

Abstract

Background: It is widely acknowledged that Donald Munro in the United States (1936) and Ludwig Guttmann in the United Kingdom (1944) are the founders of the modern treatment of spinal injuries. However, Germany was the birthplace of neuropathology and led the field in neurology and psychiatry. The first effective spinal injury units were established by Wilhelm Wagner in Königshütte, Silesia and Emil Kocher in Bern, Switzerland at the end of the 19th century. Summary: The modern principles of spinal injury treatment emanated from the work carried out by Wagner and Kocher. This knowledge was applied during the First World War in Germany, France, Austria, Switzerland and the United Kingdom. Marburg established a unit in Vienna, Dr. and Mrs. Déjerine and their team of French doctors treated casualties from the First World War and, in the United Kingdom, Gordon Holmes, George Riddoch and Henry Head treated soldiers suffering from spinal injuries in specialised units. After the war these units closed down, doctors went back to their previous occupations and the expertise gained was lost or, in the case of Germany, suppressed. It was only in 1939 when Ludwig Guttmann, a Jewish refugee, arrived in the United Kingdom that this specialised knowledge was used to set up satisfactory treatment. Key Messages: Many of the key principles of treatment for spinal injuries were developed at the end of the 19th century and during the First World War but units closed down and the knowledge gained was forgotten. With the advent of the Second World War, German refugees, many of whom had worked in the field of neurology (including Ludwig Guttmann), came to the United Kingdom armed with a thorough training in neurology and rehabilitation and applied these principles to the treatment of spinal injuries for the benefit of the country which gave them refuge.

Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury

“…Spinal cord neurons have critical interactions with astro- and microglia and around blood vessels where the blood-brain-barrier (BBB) is formed. The neuroglial extracellular space contains small quantities of extracellular matrix (ECM) glycoproteins and proteoglycans that anchor cellular cytoskeletons and stabilize synapses [ 6 , 7 ]. A significant consequence of SCI is disruption of this structure followed by scarring and infiltration of fibrotic cells that generate a permanently disorganized ECM [ 8 ].…”

Acute Traumatic Spinal Cord Injury in Humans, Dogs, and Other Mammals: The Under-appreciated Role of the Dura

“…Mild SCIs may be managed conservatively. For severe SCI, conservative management was advocated in the early and mid-twentieth century (18), but the current trend is early surgery to eliminate the extradural cord compression and spinal instrumentation to stabilize the spine and prevent further cord damage. Whether early bony decompression improves neurological outcome is controversial (19)(20)(21).…”

Linking spinal cord injury rehabilitation between the World Wars: The R. Tait McKenzie legacy

“…One of the legacies of World War I, which inspired pioneers of SCI medicine, was the founding of categorical peripheral nerve injury (PNI) centers. 4 Charles H. Frazier, professor of neurosurgery at the University of Pennsylvania who trained Donald Munro (1916), was credited with the establishment of the first PNI treatment facility in the US in 1918, which coordinated specialized care, rehabilitation and research. 10,11 In the United Kingdom 27 Recently, Frazier and McKenzie were paired together "as Americans" in a history of "military medical care for peripheral nerve injuries during World War I", 11 since both worked in reconstruction hospitals, Frazier in the US and McKenzie (Figure 1) in the UK under Sir Robert Jones.…”

“…Guttmann, who worked for years on peripheral nerve injuries, cited the categorical approach of specialized care and rehabilitation pioneered by Jones, Frazier and his mentor Foerster in 1942, 31 Silver attributes Guttmann's experience with peripheral nerve injuries as the inspiration for Guttmann's later development of the famed Spinal Cord Injury Center at Stoke Mandeville Hospital in Aylesbury, England in 1944. 4,9 World War II and SCI Care in Canada…”

“…Peripheral nerve injuries in Germany, England, and the US, served as the model for categorical comprehensive care. 3,4 While pioneers such as Sir Ludwig Guttmann, 5 Harry Botterell and Albin Jousse, Donald Munro, 6 Ernest Bors 7 and Estin Comarr 8 are well recognized for their contributions to the restoration of function in wounded soldiers during World War II, comparatively little recognition has been given to the origins of their comprehensive approach to SCI care. 9 During World War I, Otfrid Foerster in Germany and Charles H. Frazier in the US reported on a large series of 3000 to 4000 cases of peripheral nerve injuries requiring restorative services of physical treatment, training, and vocational assessment.…”