December 2017 Edition. Volume XVII

Of all of the early physician pioneers who recognized the importance of obtaining a better understanding of the function and structure of the lumbar spine Harry Farfan has been the least known and appreciated by the medical community.  The reasons for this are many but do reflect a most fascinating tale of a brilliant and proud physician/ scientist.  His residents at Montreal General Hospital described him as the best surgical technician who was also the most demanding.  It didn’t occur to them at the time but much of his behavior reflected his striving for excellence and his constantly putting them “to the test.” Harry Farfan was not easy to understand.  Much of what he presented (often as a result of his own painstaking research based on personal anatomic dissections) seemed difficult for others to grasp.  He was however typically “right on target” in his diagnoses and predictions regarding the patient’s prognosis.

Alex Hadjipavlou, who was a orthopedic resident at Montreal General Hospital in 1969, pointed out that while the house staff gave Harry Farfan immediate respect it took time for them to understand him.  Some people never did.  Perhaps a reason for this was a type of Gallic pride which sometimes got in his way.  One example of this was his unwillingness to accept offers for academic advancement which others would have rushed to accept.  Harry Farfan was clearly cut from a different mold than most of his colleagues.

This was not to say that his work and friendship were not shared by many contemporaries.  He frequently shared cases and discussed his work with William Kirkaldy-Willis in Saskatoon, Canada.  If fact it was Kirkaldy-Willis who often served to “translate” to others Farfan’s many innovative and creative premises. Following his initiation of the ISSLS in 1974 fellow orthopedists and colleagues in other disciplines began to become aware of Harry Farfan’s work.  Under the guidance of William Kirkaldy-Willis a meeting “The Relation Between Pathological Anatomy And X-Ray and C.T. Scan Findings In The Lumbar Spine (With Special Emphasis On Rotational Changes) was held in the Farfan Laboratory at Saint Mary’s Hospital in Montreal, Canada on September 26-27, 1980.  This became the first of the Farfan “Expeditions.”  In addition to Drs. Farfan and Kirkaldy-Willis and invited house staff members the meeting faculty included Charles Burton,  Judith Donovan-Post, Romeo Ethier, Kenneth Heithoff,  Stanley Tchang, and Kenneth Yong-Hing.  The “expedition” provided a optimal environment for the group to discuss and explore many of the emerging philosophies regarding the lumbar spine and its function.

Some of the perceptions presented at this meeting by Harry Farfan included the following:

Segmental rotational change can change the relative length of spinal nerve roots producing nerve root stretch on one side.

Vertebral canting can also place stretch on a nerve root.

Old laminar fractures are not unusually seen in lumbar spines.

Juxtaarticular traumatic stress fractures are often seen in the inferior articular process next to the facet joint and parallel to the joint.

These juxtaarticular fractures can occur on both sides of the vertebral pedicle.

Growth of the mamillary process of the facet joint produces facet hypertrophy.

The hypoplastic facet joint is the side on which the disc usually herniates.

Strain and sprain injuries cause temporary spinal dysfunction.

Disc and facet joint degeneration lead to dynamic spinal instability.

Fixed deformities lead to the development of central and lateral spinal stenosis.

On September 18-19, 1981 the second “Farfan Expedition” was held in Minneapolis, Minnesota (a week after the ISSLS meeting in Paris) organized by the Editor.  In addition to Drs. Farfan and Kirkaldy-Willis the participants included: Harvey Aaron (Physical Medicine and Rehabilitation), Hank Cramer (Radiology), Judith Donovan-Post (Radiology), Alex Lifson (Neurosurgery),  Alex Hadjipavlou (Orthopedics), Kenneth Heithoff (Radiology), Matthew Kalman (Radiology), Keith Millett (Orthopedics), Stanley Paris (Physical Therapy), Charles Ray (Neurosurgery), Murthy Tadavarthy (Radiology), Richard Salib (Orthopedics), Stanley Tchang (Radiology), and Kenneth Yong-Hing (Orthopedics).

Following the first two formal “Expedition” meetings subsequent sessions were held on a more informal basis.  The Montreal/ Minneapolis connection was the beginning of a more intense interdisciplinary exchange and led to interinstitutional studies such as the one regarding one documenting the reasons for spine surgery
failures.  Most important was the opportunity for Harry Farfan’s peers to be exposed to his research and teaching.  This has served as an important basis upon which spine care has progressed.

 

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