Lessons to be learned from Cushing’s early treatment of IM spinal cord tumors
Neurosurgery pioneer Harvey Cushing’s unpublished writing, “Technique of Laminectomy” revealed the challenges in pathological classification, preoperative diagnosis, tumor localization and surgical techniques for intramedullary spinal cord tumors during his era, according to researchers who recently analyzed this work for the first time.
The researchers also explored Cushing’s first three documented intramedullary spinal cord tumor (IMSCT) cases performed at Johns Hopkins Hospital. After internal review board approval, the investigators opened the surgical files dated 1896 to 1912.
They noted that Cushing, who was mainly known for his contributions to brain tumor surgery, also pioneered developments in spinal cord surgery.
The three patients with an IMSCT had a mean age of 26 years. Two patients underwent decompressive laminectomies with cyst evacuation without tumor resection and one patient underwent a decompressive laminectomy with partial tumor resection. Two patients were discharged with an “improved” condition and one patients was discharged with an “unimproved” condition, the authors noted.
Researchers found Cushing used laminectomy to approach patients with metastatic lesions to the spine, Potts disease, migraine, deformities after poliomyelitis or extra-axial spinal cord tumors. They concluded Cushing demonstrated only limited success in treating IMSCTs, but in these patients he was able to manipulate the spinal cord during the procedures without permanent neurological damage, postoperative infection or complications. This result, they said, was a testament to his operative technique and surgical skills. – by Robert Linnehan
Disclosure: Pendleton reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.