A Historical Review of the Surgical Treatment of Spina Bifida

  • James T. Goodrich


Spina bifida or spinal dysraphisms have been present as long as man has walked the planet. A number of anthropological excavations have uncovered spines with stigmata typically seen in infants born with myelomeningoceles. As these children were born in an era where little or no treatment was available we can only assume that most did not survive. Having said that, there are a large number of surviving anthropological figures sculpted in stone, terracotta and other materials from early civilizations. These sculptures provide evidence of individuals who survived with what would be a normally devastating disease. Over the years the author has collected a number of terracotta figures from the Americas that show clear evidence of surviving children with stigmata of spinal dysraphism. These figures are seated in the typical position of a paraplegic child or adult with the typical lumbar kyphosis. Some of the figures have been incorrectly described as patients with tuberculosis or Pott’s disease. A careful examination of these figures clearly shows the physical characteristics of individuals with chronic myelomeningocele. We have included several examples that come from Meso-American cultures where figures of this type are not at all uncommon (Figs. 1.1–1.5).


Spina Bifida Club Foot Historical Review Spinal Dysraphism Title Page 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hippocrates. In: Kühn CG (1825) Medicorum graecorum opera quae exstant. Leipzig, C, Cnoblochius, Volume 21, p 500Google Scholar
  2. 2.
    van Forestus P (1610) Observationum et curationum chirurgicarum Libri Quinque Lugduni Batavorum (i.e., Leyden), Ex. Officiana Plantiniana RaphelengiiGoogle Scholar
  3. 3.
    Tulpius N (1641) Observationes medicae. Amsterdam Elzevirium, see Libri III, pp 231 for illustration and plateGoogle Scholar
  4. 4.
    Furukawa T (1987) First description of spina bifida by Nicolaas Tulp. Neurol 37:1816–1828. See also Rickham PP (1963) Nicolaas Tulp and spina bifida. Clin Peds 2:40-42Google Scholar
  5. 5.
    Severinus, Marcus Aurelius (1632) De Recondita abscessum natura. Neapoli, BeltranumGoogle Scholar
  6. 6.
    Severinus, Marcus Aurelius (1724) De Abscessuum Recondita Natura: Libri VIII, Editio novissima, Lugduni Batavorum, apud Joannem a KerckhemGoogle Scholar
  7. 7.
    Ruysch F (1691) Observationum anatomico-chirurgicarum centuria. Amsterdam, Apud Hnricum & viduam Theodori BoomGoogle Scholar
  8. 8.
    Ruysch F (1751) The celebrated Dr. Frederic Ruysch’s practical observations in surgery and midwifery. T. Osborne, London. See Walker, AE (ed) (1951) A History of Neurological Surgery. Baltimore, Williams and Wilkins, pp 352–353 for quoteGoogle Scholar
  9. 9.
    Guillemeau, Jacques (1635) Child-Birth; or, The Happy Delivery of Women Wherein is set downe the Government of Women in the time of their breeding Childe: of their Travaile, both Natural and contrary to Nature: and of their lying in Together with the diseases. London, Anne Griffin for Joyce Norton and Richard WhitakerGoogle Scholar
  10. 10.
    Morgagni JB (1761) De sedibus, et causis morborum per anatomen indagatis libri quinque. Venice Ex. Typographia RemondinianaGoogle Scholar
  11. 11.
    Morgagni JB (1765) De sedibus, et causis morboum per anatomen indagatis libri quinque. Patavii: Sumptibus RemondiananisGoogle Scholar
  12. 12.
    Cruveilhier J (1829–1842) Anatomie pathologique du corps humain. JB Baillière, ParisGoogle Scholar
  13. 13.
    Flamm ES (1973) The neurology of Jean Cruveilhier. Medical History 17:343–355PubMedGoogle Scholar
  14. 14.
    Baxter M (1882) Chronic hydrocephalus with meningocele. Med Times Gaz I:239–249Google Scholar
  15. 15.
    Lebedeff A (1881) über die Entstehung der Anencephalie and Spina bifida bei Vögeln und Menschen. Virchows Arch 86:263–273CrossRefGoogle Scholar
  16. 16.
    Kermauner F (1909) In: Schwalbes: die Morphologie der Missbildungen des Menschen und der Tiere, III, Teil 3:86–94, Jena, Gustav FischerGoogle Scholar
  17. 17.
    Keiller VH (1922) A contribution to the anatomy of spina bifida. Brain 45:31–41CrossRefGoogle Scholar
  18. 18.
    Bohnstedt, G (1895) Beitrag zur Kasuistik der spina bifida occulta. Arch f Path Anat 140:47–57CrossRefGoogle Scholar
  19. 19.
    Fuchs A (1910) über Beziehungen der Enuresis nocturna zu Rudimentärformen der Spina bifida occulta (Myelodysplasie). Wien med Wochnschr 60:1569–1573Google Scholar
  20. 20.
    de Vries E (1928) Spina bifida occulta and myelodysplasia with unilateral clubfoot beginning in adult life. Am J M Sc 175:365–371CrossRefGoogle Scholar
  21. 21.
    Lichtenstein BW (1940) Spinal dysraphism: Spina bifida and myelodysplasia. Arch Neurol Psychiatry 44:792–809Google Scholar
  22. 22.
    Lichtenstein BW (1942) Distant neuroanatomic complications of spina bifida (spinal dysraphism): Hydrocephalus, Arnold-Chiari deformity, stenosis of Aqueduct of Sylvius, etc. Pathogenesis and pathology. Arch Neurol Psychiatry 47:195–214Google Scholar
  23. 23.
    Bell B (1787) A system of surgery. Edinburgh: C. Elliott. See volume 1, pp 245–249 for operative technique on spina bifida. See p 246 for quoteGoogle Scholar
  24. 24.
    Cooper A (1811) Some observations on spina bifida. Medico-Chirurgical Transactions 2:443–447Google Scholar
  25. 25.
    Cooper S (1830) The first lines of the practice of surgery; ... with notes by Alexander H. Stevens. Third American, from the fifth London edition. Philadelphia, John Grigg. See vol 2, pp 346-347Google Scholar
  26. 26.
    Cooper S (1830) The first lines of the practice of surgery; ... with notes by Alexander H. Stevens. Third American, from the fifth London edition. Philadelphia, John Grigg. See vol 2, pp 347Google Scholar
  27. 27.
    Morton J (1872) Case of spina bifida cured by injection. Brit MJ 1:632–633Google Scholar
  28. 28.
    Palasciano F (1897) Memorie ed osservazioni del Prof. Ferdinando Palasciano. Postmortem ed. Napoli: traniGoogle Scholar
  29. 29.
    Rizzoli F (1872) Memoires de chirurgie et d’obstétrique. Paris: Delahaye. For a further discussion on Rizzoli see also Guidetti B, Giuffrè B, Valente V (1983) Italian contribution to the origin of neurosurgery. Surg Neurol 20:3357#x2013;336Google Scholar
  30. 30.
    Ahlfeld F (1880-1882) Atlas zu die Missbildungen des Menschen. Leipzig, Fr Wilh GrunowGoogle Scholar
  31. 31.
    Lebedeff A (1882) Lehrbuch des allgemeinen pathologische Anatomie. Berlin, Druck und Verlag von Georg Reimer, p 297Google Scholar
  32. 32.
    von Recklinghausen F (1886) Untersuchungen über die Spina Bifida. Berlin, Druck und Verlag von Georg Reimer. See also von Recklinghausen F (1886) Recherches sur le spina bifida. Arch f Path Anat und Physiol 105:31–41Google Scholar
  33. 33.
    Virchow R (1875) Ein fall von hypertrichosis circumscripta mediana, kombiniert mit spina bifida occulta. Ztschr f Ethnol 7:280–290Google Scholar
  34. 34.
    Morton J (1877) Treatment of spina bifida by a new method. Glasgow, J. MaclehoseGoogle Scholar
  35. 35.
    Marcy HO (1895) The surgical treatment of spina bifida. Annals of Surgery 20:70–76Google Scholar
  36. 36.
    Forster JC (1860) The surgical diseases of children. Parker, LondonGoogle Scholar
  37. 37.
    Wyeth JA (1887) Text-book on surgery, general, operative, and mechanical. Appleton, New York, p 712Google Scholar
  38. 38.
    Park R (ed) (1896) A treatise on surgery by American authors. Lea Brothers & Co, Philadelphia, 2:80–84Google Scholar
  39. 39.
    Wilcox SF (1909) Surgery of childhood. Boericke and Runyon, New YorkGoogle Scholar
  40. 40.
    Bayer C (1892) Zur technik der operation der spina bifida und encephalocele. Prag med Wchnschr 17:317, 332, 345Google Scholar
  41. 41.
    Chipault A (1894–95) Chirurgie opératoire du système nerveux. Avec une preface de M. Le Professeur Terrier. Paris: Rueff et c. EditeursGoogle Scholar
  42. 42.
    Chiari H (1891) über Veränderungen des Kleinhirns in Folge won Hydrocephalie des Grosshirns. Dtsch med Wschr 17:1172–75. An English translation of this paper was published in 1987. Chiari H (1987) Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. 1891. Pediatr Neurosci 13:3–8Google Scholar
  43. 43.
    Chiari H (1896) über Veränderungen des Kleinhirns, des Pons und Medulla oblongata infolge von kongenitaler Hydrocephalie des Grosshirns. Denkschriften der Kais Akad Wiss math-naturw Wien 63:71–116Google Scholar
  44. 44.
    Carmel PW, Markesbery WR (1972) Early description of the Arnold-Chiari Malformation. J Neurosurgery 37:543–547Google Scholar
  45. 45.
    Burke JR, Massey EW (1990) Hans Chiari. In: Ashwal S (ed) The founders of child neurology. Norman Publishing, San Francisco, pp 190–195Google Scholar
  46. 46.
    Brockhurst G (1976) Spina bifida for the clinician. Clinics in developmental medicine No. 57. William Heineman Medical Books, London, pp 7–11Google Scholar
  47. 47.
    Chiari H (1884) Ueber einen Fall von Luftansammlung in den Ventrikeln des menschlichen Gehirns. Ztschr F Heilk 5:383–390Google Scholar
  48. 48.
    Cleland J (1883) Contributions to the study of spina bifida, encephalocele, and anencephalus. J Anat Physiol 17:257–292. For a historical review see a paper by Koehler PJ (1991) Chiari’s description of cerebellar ectopy (1819) with a summary of Cleland’s and Arnold’s contribution and some early observations on neuraltube defects. J Neurosurg 75:823–826PubMedGoogle Scholar
  49. 49.
    Arnold J (1894) Myelocyste, transposition von Gewebskeimen und Sympodie. Beitr path Anat allg Path 16:1–8Google Scholar
  50. 50.
    Schwalbe E, Gredig M (1907) über Entwicklungsstörungen des Kleinhirns, Hirnstamms und Halsmarks bei Spina bifida. (Arnold’sche und Chiari’sche Missbildung) J Beitrage sur pathologischen Anatomie. 40:132–144Google Scholar
  51. 51.
    Frazier CH (1918) Surgery of the spine and spinal cord. D Appleton & Co, New YorkGoogle Scholar
  52. 52.
    Ingraham FD, Hamlin H (1943) Spina bifida and cranium bifidum; surgical treatment. N Engl J Med 228:631–641Google Scholar
  53. 53.
    Sharrard WJ, Zachary RB, Lorber J (1967) The longterm evaluation of a trial of immediate and delayed closure of spina bifida cystica. Clin Ortho Res 50:197–207Google Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • James T. Goodrich
    • 1
  1. 1.Division of Pediatric Neurosurgery Plastic Surgery and Pediatrics Children’s Hospital at Montefiore Montefiore Medical CenterAlbert Einstein College of MedicineBronxUSA

Personalised recommendations