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The History of Spinal Disease in Medicine

Posted on: 04/18/2008
Although back pain and spinal disease have been around for generations, it has only been in the past 70 years that spinal care has seen major developments in spinal care. This article reviews the history of spinal disease and care, as well as the diagnosis and the implications of treatment.

Because the cause of back pain was poorly understood, as recently as before the mid-1800s, only the symptoms of spinal disease were treated. In the mid-1840s, there developed an understanding of the pathophysiology of the body and the back, leading to the beginning of understanding the causes of spinal disease.

At this point, doctors began putting together the similarities in patient complaints and grouping the similar complaints into disease entities. When this happened, researchers could focus on one particular disease and its diagnosis and management.

As their knowledge grew, the development of chemical and mechanical treatments progressed. Many of the problems that were treated in the previous two centuries are now rarely seen, such as polio, systemic tuberculosis, and others.

The "biomechanical model," which arose from the earlier years affected all aspects of medical care, including spinal care. Doctors and researchers moved from focusing on symptoms and deformities to more in-depth issues. By 1841, in an autopsy, a physician found evidence of disc protrusions and this was followed by similar discoveries by others in the following years. Although surgery may have occurred as early as 1896, the first noted surgical intervention occurred in 1909, when a disc herniation was removed from a patient experiencing paralysis.

In 1929, two cases of discectomies were reported and spinal surgery continued to grow and develop. The literature included articles on intervertebral disc herniation as a disease entity that could be diagnosed. This diagnosis progressed over the decades from clinically to myelographically, to computed tomography, and now through magnetic resonance imaging.

Throughout the mid-19th century, diagnosis were not yet done; rather, physicians described their findings, but the use of the biomedical model led to diagnosis, which is now the driving force behind treating. Physicians have a diagnosis and then they treat.

Treatment, originally through trial and error, became based on experience over the years, but has now become based on randomized trials and care guidelines. As well, patients are having more say in their care as they become more informed and educated in health and medical matters.

The rise of specialty medicine also came to be and specialties such as spinal surgery resulted from that first discovery of disease categories.

There are both positive and negative implications with the biomedical model and its disease categories, methods of diagnosis and therapies. On the positive side, this has allowed the medical field to eliminate or drastically reduce many of the ills of the past. The negative side, however, has a few issues.

People with diseases are unique. Their diseases and diagnosis may be common among others, but the individuals are unique. There are many outside factors that should be taken into account when a diagnosis is made, although this was not immediately apparent in the earlier days of medicine. It was only in the mid-1960s that this individuality began to be addressed, and only in the 1970s when it was addressed in more depth. Psychiatric disease was adapted to somatic disease in 1977 and spinal disease in the 1980s.

By encompassing this approach, the proponents believe that the more complicated spinal diseases are not good representatives of the biomechanical model, but that patients with spinal disease are unique, with their biologic, psychological, and social factors. This leads to the Biopsychosocial Model, which has gained widespread acceptance in the spinal care community.

Another negative implication is that of the creation or emergence of new categories. Newer syndromes or problems are still being treated as the older problems and this may not be appropriate. Another concern is the inappropriate use of disease categories to use or restrict care. In this day and age of high healthcare costs, some people are concerned that those people making payment decisions may be making their decisions based on old models.

The introduction of other players into healthcare, such as the government or insurance, is another negative implication. The concern is with these people making the decisions, as well. Finally, the last negative implication is the iatrogenesis, or inducing of patient complaints as the result of diagnosing disease.

The author of this article concludes that the act of placing a diagnosis on spinal disease is what sets the wheels into motion in terms of medicine and social (finances, for example). Knowing that diagnosis does have such a power, the author suggests that physicians be aware of what can be caused by the pronouncement of a diagnosis and be prepared for the outcome.

References:
Bradley K. Weiner, MD. Historical Perspective, The Development and Use of Spinal Disease Categories. In SPINE. April 2008. Vol. 33. No. 8. Pp. 925-930.

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