Harry Crock and his identical brother (the ophthalmologist) were born and educated in Perth, Australia. Harry Crock had the good fortune, as a young orthopedic trainee in 1954, to have met, and been influenced by, Joseph Barr (Mixter WJ, Barr JS: Rupture of the Intervertebral Disc with Involvement of the Spinal Canal, NEJM 211:210, 1934) when he was visiting Melbourne. He also had the good fortune to have been provided with a discerning nature which allowed him to appreciate that not all back problems were related to “herniated discs.” This, for its time, represented heretical thinking. Few heretics end up being appreciated by their peers. Harry Crock is an exception to this and he was deservedly esteemed to be the leading spine surgeon in Australia (i.e. Order of Australia in 1984) because of his many contributions. His interest in anatomical studies, particularly those on the blood supply of the skeleton and spinal cord, have aided in bringing to the forefront the body anatomy so often ignored in the past. His anatomic descriptions and technologic advances in instrumentation and surgical technique have benefited colleagues and patients in many ways. The gamut of his interests have had wide range and have included important, but obscure, studies on subjects such as adhesive arachnoiditis ossificans. His publications on spinal surgery have not just been directed to technique but also on making spine surgery safer for the patient.
Walter E. Dandy (1886-1946) was the second Professor of Neurological Surgery at Johns Hopkins Hospital in Baltimore, Maryland; Harvey Cushing was the first. While Harvey Cushing was acclaimed as one of the very first neurosurgeons in the United States Walter Dandy became the penultimate neurosurgical technician who took delight in accomplishing the surgical challenges which Harvey Cushing said couldn’t be done. Walter Dandy was the master at solving the many challenging, and sometimes lethal, risks inherent in the new surgical endeavor called “neurosurgery.” Walter Dandy’s legendary “bloodless” surgical approach to the posterior fossa of the skull was “bloodless” only if the operating surgeon knew the Dandy techniques regarding pitfall prevention. The Dandy Dogma was simple: “know the hazards and avoid them.” Dr. Dandy’s three most important contributions to the future discipline of spine care were the introduction of ventriculography and air myelography, the demonstration of the circulation of the cerebro-spinal fluid and in 1929 he was the first to recognize the true nature of the “herniated disc” as being a herniation of intervertebral cartilage rather than a tumor and its relationship to sciatica and associated neurologic deficit (Dandy WJ: Loose Cartilage from Intervertebral Disc Simulating Tumor of the Spinal Cord, Arch Surg, 19:660-672, 1929). His work was published 5 years before Mixter and Barr first reported on the very same entity. Because the prevalent thinking at the time could only relate to tumors (one sees only what one knows) he was the very first person to actually document that this “tumor” was really extruded cartilage. Dandy could not know that “the herniated disc” would subsequently become an obsessive preoccupation for those who followed him in diagnosing and treating spine disorders long after he was gone (to the detriment of identifying other important pathological entities such as lateral spinal stenosis). Accompanied in the surgical theater by his personal medical illustrator, Dorcas Hager Paget), Dandy meticulously documented a wealth of spinal surgical pathology as well as his innovative surgical techniques. When he died, as a result of coronary thrombosis in 1946 his career at Johns Hopkins Hospital had spanned 30 years. Dandy was clearly the initiator of the flowering era of spinal care and spinal surgery in the United States in the 20th century. In his time there were very few who demonstrated any real interest in this endeavor. The proof of this observation is that the spine, and its associated structures, for many years afterwards were largely ignored on medical school cadavers as well as on the autopsy tables. Walter Dandy initiated a new discipline and, in the process, also initiated a progression of spinal diagnostic procedures which have served as the nidus for a progression of increasingly sophisticated non-invasive diagnostic tools.
Medical practice and the welfare of patients were blessed when there appeared on the scene someone who asked not for personal gain and was also willing to serve as a champion and joust the forces organized for self-serving agendas. Anthony (Tony) Dwyer is a true modern hero. As the “front man” for the organization of a American Board of Spine Surgery he “led the charge” against a parochial medical establishment in an admirable fashion. Born in Melbourne, Australia of Irish-Australian parents he competed with 4 siblings and struggled to obtain a medical education. Good fortune began to smile on him when, as an intern, at St. Vincent’s Hospital, he had the good fortune to work with Sir Harry Crock. This good fortune continued in Oswestry (England) for orthopedic training at the Robert Jones and Agnes Hunt Orthopaedic Hospital and then the Orthopaedic Department at the Queen Mary Hospital (Hong Kong) under the direction of Prof. A. R. Hodgson. From there to Australia, Boston (Massachusetts), Australia, Little Rock (Arkansas), New Orleans (Louisiana), and Denver (Colorado) Tony Dwyer has taken the measure of his peers and his patients and we have all benefited from this. After 10 years on the faculty of the University of Colorado he shifted his expertise to the Spine Service at the Denver Health Medical Center. Few in the practice of spine surgery have had better training. Few also, in spine surgery, have had as devoted a wife as Judy Dwyer who has gone along with all of this.
Harry Farfan (1924-1994) was instrumental in bringing forth the new specialty of spine care and spine surgery. Although he was born in Trinidad, West Indies to a family of Spanish descent, the majority of his University, medical school and residency training were in Montreal where he spent most of his professional life. After obtaining his degrees in biochemistry and medicine at McGill University he spent three formative years in England tutoring under Norman Capener, Dennis Dunn and Sir Osmond Clarke. When he completed his orthopedic training, a common teaching was to avoid treating back problems because “no one ever got better.” Today the greatest number of fellowships in Orthopedics and in Neurosurgery are in spine. This dramatic turn-around in attitude has reflected the great strides in diagnosis and treatment which have occurred over a relatively short period of time. Harry Farfan was one of the important pioneers in effecting this perceptual change. His clinical observations and laboratory studies on the role of spinal mechanics and the effect of accumulated “insult and injury” on human spines attempting to successfully ambulate on a high gravity planet served to promote interest and inquiry by others. The Farfan publications on rotational and compressional forces and the three-joint complex were important catalysts in initiating the present understanding of these subjects. Harry Farfan was also instrumental in influencing his colleagues in joining together to combine their talents for the purpose of advancing the then emerging specialty of spine care. He was the founder of the International Society for Study of the Lumbar Spine and was a key force behind the merging of the North American Lumbar Spine Association (NALSA) and the American College of Spine Surgeons (COLS) to form the North American Spine Society in Laguna Niguel, California on July 24, 1985. Harry Farfan served as the moderator of this conference and through his leadership talents he was able to bring the different physician specialists together in a harmonious joint endeavor . This effort was instrumental in allowing spine care, the “dog” of the past, to begin to assume its present role as the “darling” of orthopedics and neurosurgery today.
Bill Glenn trained at Johns Hopkins, Washington University and Harvard. As a brilliant radiologic “techno weenie” one would have thought it more natural for him to have trained at the Massachusetts Institute of Technology. Spine imaging was in a sad state of affairs when Bill Glenn appeared on the scene. Oil, and then, water soluble myelography were the “gold standard” at that time. As the father of multi-planer computerized spine imaging he was rightfully proud of his handiwork. Then came the Annual Meeting of the American Association of Orthopaedic Surgeons in Atlanta in 1984. This Editor remembers well Glenn’s fascinating presentation at this meeting as well as the following discussion in which a well known Swedish spine specialist disparaged Glenn, and his presentation, and stated that his contribution added nothing to spine diagnosis and that it was unlikely that CT “would ever have any useful role in the diagnosis of spine disorders in the future.” The same spine specialist subsequently touted myelography over CT in the diagnosis of lateral spinal stenosis. Time has proven Glenn to have been right on all counts. He has been referred to as only a “private practice radiologist from California.” Our “hat’s are off” to this brand of private practice.
Ken Heithoff was not the developer of spine imaging nor the inventor of the MRI. He was, however, a real pioneer in identifying what this imaging actually demonstrated so that those who have dedicated themselves to studying the pathophysiology of the spine (such as William Kirkaldy-Willis; shown with Heithoff above) and those attempting to make specific diagnoses in order to treat patients intelligently could have objective information upon to base their decisions. Even today there are only a handful of radiologists who are uniquely expert in spine imaging. This situation has been particularly unfortunate in the failure of many radiologists to identify congenital genomic spine disorders. Heithoff and associates were the very first to publish a clinical study on Juvenile Discogenic Disease. His continuing efforts to clarify this condition have extended to genomic investigations in spine patients, their siblings, and parents. In the old west it was the pioneers who received most of the arrows. When Heithoff first began to report radiologic entities other than just herniated discs and spondylolisthesis he was accused of “playing into the surgeon’s hands” as a means of justifying unecessary spine surgery. To his great credit he persisted despite the obstacles placed in his path.
As the practice of the healing arts has advanced over the ages it has not been unusual to observe the phenomenon of truly important and innovative advances being dismissed, out of hand, by the medical community. Such was the fate of Philip Semmelweis whose observation that the washing of hands was an important preventive measure in avoiding maternal death from puerperal fever. This was something which was never acknowledged or practiced during his lifetime. Fortunately, Fred Kahn, M.D. may yet achieve the recognition he deserves from the medical community while he is still around to acknowledge this. Safe and effective medical devices and associated therapies are sometimes lost in the shuffle when compared to the mass marketing of pharmaceuticals and surgery. Dr. Kahn’s medical career began as a graduate of the Faculty of Medicine at the University of Toronto and led to the practice of ardiovascular surgery in the United States following which Dr. Kahn focused his interest and energy in the healing potential of Low Intensity Laser Therapy. Starting in 1988 he has pioneered the development and clinical application of cold laser therapy. Dr. Kahn’s inventions and his treatment protocols have continually demonstrated a high level of safety, efficacy, and cost effectiveness in treating pain as well as in wound healing. Remarkably, Dr. Kahn’s effort has received little in the way of acknowledgement except from his patients; many of who have suffered from disabling back pain. It is therefore a privilege for Burton Report to add Dr. Fred Kahn’s name to its Spine Hall of Fame.
Elizabeth Kenny (1880-1952) began her career as a voluntary aide. She was a self-taught bush nurse in Toowoomba, Australia and enrolled in the Australia Nursing Service, as a staff nurse, in 1910. Her promotion to the rank of lieutenant reflected her industry and efforts on behalf of her patients. The honored title of “Sister” probably reflected her status as a head nurse. Her theories regarding the treatment of children afflicted with polio were brilliant for their time and diametrically different from those of mainstream medicine. For this she was vilified and continually attacked as being a fraud by the medical establishment. Her therapies designed to rehabilitate impaired muscles and to retrain the nervous system were, however, based on careful observation, deduction, and a willingness to listen to her patients. It took great spirit for Sister Kenny to maintain her integrity while under constant attack by the establishment. In 1938 at the behest of Australian physicians a Royal Commission condemned her work as being “unorthodox” and her procedures “dangerous, damaging, costly and cruel.” It was in Minneapolis where she finally found a group of sympathetic physicians whose minds were open enough to give her theories a chance. With their assistance, and that of the city of Minneapolis, a Rehabilitation Institute (which still bears her name) was founded in 1942. A most important result of Sister Kenny’s work was her influence on others to establish the basic concepts of spine rehabilitation and allow it to spread throughout the world. Perhaps the most remarkable event of this saga was that many years after her death, the American medical establishment finally acknowledged that she was right and that they were wrong. It is interesting to note that Sister Elizabeth Kenny was never selected to be the “poster girl” for the feminist movement. She should have been. Although John Wayne played the role in the movies Sister Kenny practiced “true grit” in real life.
William Kirkaldy-Willis (Feb. 26, 1914-May 7, 2006) was someone uniquely gifted as a human being, physician, teacher, and scientist to bring logic and understanding to the Tower of Babel called spine care and spine surgery. A product of the English school system and Cambridge college and medical school, K-W was blessed with a disarming charm. His apparently self-effacing demeanor concealed an incisive wit and a lifetime search, akin to Diogenes, to identify those with, and without, integrity in their medical practices. K-W was clearly one of the true giants in medicine as well as spine care. His philosophies and his many brilliant medical contributions have clearly not yet been well appreciated by the medical community (much akin to the medical profession’s failure to appreciate the advice of Phillip Semmelweis). His life’s work will however serve as his legacy. K-Ws many interests, skills and humanitarian concerns have, however, been more readily apparent to all. K-W was a luminary among other luminaries who were his close associates ( i.e. Leon Wiltse, Harry Farfan and Harry Crock). K-W also allied himself with the full spectrum of health professionals involved in the spine care whether they be M.D.s, D.O.s, PhDs, Physical Therapists, Chiropractors, Exercise Therapists, Trainers or School Teachers. K-Ws lifetime interest in spine resulted from his frustrations in attempting to do more for his patients disabled from spinal tuberculosis during his years as a medical missionary in Mombasa, Kenya in the 1940s. In 1965 he began his 23 year association with the Department of Orthopedics at the University Hospital in Saskatoon, Saskatchewan, Canada. During this period of time his insight into spinal disease and his unique ability to understand and advance the work of others led to his proposing a unified theory of spinal pathophysiology for which he coined the term “The Degenerative Cascade.” This landmark work which has been well described in his numerous publications including the four volumes of his textbook “Managing Low Back Pain” (Churchill Livingstone, Publishers). It continues to serve as an important roadmap for those with a interest in traveling the “spinal highway.” Few diamonds have exceeded, in the number of their surfaces the many facets of talent possessed by Dr. K-W. On the medical side these have included non-invasive treatments as well as surgery and the importance of back education, exercise, prevention and health maintenance programs. His vision and persistence were key in bringing organization to the spine establishment as a primary co-founder of the North American Spine Society. Less well known have been his accomplishments in art, botany, missionary work, philosophy and other humanitarian endeavors. His wife, Betty Kirkaldy-Willis, has been another North American spine pioneer in her initiation of the concept of “Low Back Schools” and advocating the importance of low back education starting early in life. As a leader in the spine community Dr. K-W has worked for balance while supporting the philosophy that the patient’s welfare should be the paramount concern for the clinician.
Leonard Malis was born in Philadelphia in 1919. Following his neurosurgical residency he was a Dazian Fellow in neurophysiology at Yale under John Fulton. It was during this period of time that he introduced the first true bipolar coagulator which was introduced into clinical use in 1953. As a member of the faculty of the Mount Sinai School of Medicine he was elevated to Chairman of the Department of Neurosurgery in 1970. His interest in microsurgery began in 1965 and by 1967 he had limited his practice to microsurgical procedures. A dry operative field for spine surgery was something unknown until the advent of improved patient positioning in the 1920s and hemorrhage control by cautery in 1926. It was Malis, in 1955, who first developed a true bipolar coagulating forcep. This was marketed to the profession in 1966. The introduction of bipolar coagulation was a important step in allowing spine surgeons to also become “microsurgeons.” In addition to his pioneering of safer, and more effective microsurgical cautery Malis continued, throughout his professional career (he retired from practice in 1994), to contribute in many areas including prophylactic antibiotics and surgical instrumentation.
Frank Mayfield (1897-1991)was selected as the first recipient of the Harvey Cushing Medal of the American Association of Neurological Surgeons in 1977. This was only one reflection of the many contributions he made to the neurosurgical profession during his career. He founded the Mayfield Institute in Cincinnati where much of his legacy is continued. Among his many contributions there have been some which were particularly significant to the field of spine care and are recognized here. Mayfield, in 1980, documented his 16 years of clinical experience with fat grafts and noted that they could prevent epidural and per neural scar tissue and control cerebro-spinal fluid leaks and in the repair of dural tears. He also noted that their greatest danger was the possibility neural compression. The illustration above is from his chapter in Clinical Neurosurgery (1980) “Autologous Fat Transplants for the Protection and Repair of the Spinal Dura.” It demonstrates autologous fat being sutured to the dura to close a complicated defect. His interest in the subject of adhesive arachnoiditis was an avant-garde effort for its time. He not only was interested in the clinical picture but worked with associates to better understand the nature of the cellular reactions involved. In 1983 he, and his associates, were the first to culture arachnoid cells to demonstrate their growth characteristics, morphology and cytoskeletal structure. By electron microscopy and immunofluorescence it was shown that the cell cultures derived from the arachnoid membrane were arachnoid cells alone and not fibroblasts (characteristic of the dura mater). This work made clear that in arachnoiditis the fibrosis results from the migration of fibroblasts from the adjacent dural membranes.
Neurosurgeon Charles Ray (1927-2011) was the recipient of the Industrial R&D Gold Prize for his invention of the prosthetic disc nucleus in the year 2000 but the Burton Report believes that his development of the Ray titanium threaded fusion cage was his single greatest (and least appreciated) contribution to the care of spine patients to-date. Born in Americus Georgia on August 1, 1927 and blessed with a brilliant and inquiring mind he became fluent in speaking eight languages. He was a savant globe traveler who was el-versed in medicine, engineering, philosophy and just about everything else. In one of his many (over 350) publications he pointed out to his neurosurgical colleagues that although they obtained the majority of their income from performing spine surgery this subject typically occupied less than 5% of their educational endeavors. As a president of the North American Spine Society, the American College of Spine Surgeons and the Spine Arthroplasty Society he endeavored to point out that the human spine is normally flexible and that better surgical alternatives than rigid fusion existed for the patient. As the founder of CeDaR Surgical and Raymedica he was actually the first to invent, and to manufacture, a intervertebral threaded cage which could immediately mechanically stabilize a unstable spine following adequate surgical decompression. By being an advocate of “arthrodesis” and “arthroplasty” rather than rigid “fusion” with pedicle rods and screws he has been a largely unappreciated pioneer who began to force other clinical minds, locked into obsolete and unproductive thinking, to gaze at new horizons.
If Diogenes of Sinope were sill engaged in his worldly quest to find an honest man he would doubtlessly have a broad smile on his face when he encountered Charles Rosen. Dr Rosen’s efforts to re-establish integrity in spinal care and a habit for “telling it like it is” have not always endeared him to every spine surgeon. As the founder, and President, of the Association for Ethics in Spine Surgery he has, however, given heart to the majority of his colleagues who still place their patient’s best interests ahead of their own. As a Clinical Professor of Orthopaedics at the University of California in Irvine Dr. Rosen has been in the right place for the right reasons. Unfortunately, the health care community just seems to be now coming out of a pervasive period when many in the medical profession have forgotten the basic concepts upon which the practice of medicine was based and need to be reminded of this. Hopefully, there are, and will continue to be many more Charles Rosens in our future to continue to remind us.
David Selby (1935-1997) was sometimes wrong but never in doubt. No one ever questioned where David Selby stood on an issue because he was never loath to present his viewpoint. Born in Illinois he practiced in Dallas, Texas where he surrounded himself with talented associates. His background as a paratroop combat surgeon served him well in his, sometimes irreverent, commentaries reflecting the trials and tribulations of medical politics. No one ever doubted that if the “chips were really down” and you found yourself in a foxhole it would be a real comfort to have David Selby at your side. Irreverence, in his hands, was a sometimes-beautiful thing. He was one of the few who was willing to say the things which needed to be said to those, who who were pompous and intimidating, and otherwise unchallenged. He could defuse (as well as fuse) a discussion with a well-placed comment. David Selby possessed a unique ability and strength to be able to pick up, and continue to run with, batons dropped by others. When the attempts to establish a North American Spine organization faltered David Selby was there to pump new life into the effort. He had the gift of not always taking himself seriously and, because of this, he was often able to communicate better than most with his patients. He was not only a skilled surgeon but also a skilled artisan and sculptor. He gave much more to his peers than most of them have realized.
Clearly, C. Norman Shealy, has stood out among his peers as a brilliant maverick. Few careers in medicine have spanned a greater gamut of interests or important innovations. After graduating Duke medical school Shealy completed his neurosurgical training at Massachusetts General Hospital. His devoted interest to comprehensive patient care has been unique. His interest in neurostimulation began with his family’s use of the “Electreat” transcutaneous electrical neurostimulator (TENS). He was among the first to encourage the development of solid-state TENS devices and was the first to clinically employ implanted dorsal cord neurostimulators for pain relief. Along the way he recognized the value of facet denervation as an important adjunct in the treatment of low back pain and pioneered the development of controlled percutaneous radio-frequency facet denervation. His devotion to non-narcotic pain management has had a major productive influence on American medicine. His other important contributions have included the importance of axial spine traction, biogenics, and alternative medicine. His excursions into the field of parapsychology have been more controversial. Irrespective of the subject his viewpoints have always been worthy of our sincere attention.
James “Walt” Simmons (1934-2016). Hidden behind his always self-effacing demeanor resided the remarkable talents of one of the prime movers of spine care during the latter third of the 20th century in the United States. As the originator of “The Challenge Of The Lumbar Spine” series, along with his wife Billye,they created not only the first comprehensive spine conferences bu also created the impetus to create other such organizations which followed, Each Challange Of The Lumbar Spine conference was designed to provide a comprehensive review of the existing multi-disciplinary evaluation methods, diagnostic techniques, management and surgical innovations for the experienced individual treating or working with patients with back problems. Because each conference had a different chairman and faculty the approach they were always unique and stimulating. In addition to the Challenge, however, Walt Simmons was often the catalyst by which, through his efforts, he brought together his colleagues in spine care to resolve differences and create mutual understanding thus allowing for the subsequent development of other spine specialty societies and the continued dissemination of knowledge.
Wesley Park (1927-2005) as a Professor of Anatomy at the University of South Dakota School of Medicine was a pioneer through his extensive scientific research on the vascularity of the spinal cord and nerves in providing important information which, even today, most members of the Spine Care Community are unaware of. Few clinicians know that that when spinal stenosis produces spinal nerve compression over a long period of time that this rarely causes impairment of normal neuro-physiologic function even when the iameter of the nerve is dramatically reduced. Professor Park demonstrated that when gradual spinal nerve compression occurs that it is the initial impairment of the less resilient venous return system which produces the clinical symptoms. The radiographic finding of “severe” chronic lateral spinal stenosis was not, in itself, an indication for surgery unless correlated with the patient’s clinical situation. His work on the micro-anatomy of the pia-arachnoid documented that the “percolation” of spinal fluid through this membrane accounts for 50% of spinal nerve nutrition. These data have served as a means of understanding the effect of progressive chemical meningitis (arachnoiditis) on the spinal nerves and how the deprivation of nutrients may lead to to a hyperexcitable nociceptive state.
Dr. Smith has been a medical icon in her devotion to patients suffering from the devastating disabilities associated with clinically significant adhesive arachnoiditis and other chronic pain syndromes. She has also been one of the very few physicians who have devoted their professional time to this challenging group of patients for which there have been no easy answers. Dr. Smith became a patron of the United Kingdom charity, the Arachnoiditis Trust in 1998 and has continued to tirelessly work with patient groups around the globe. She has published numerous articles on Arachnoiditis including a handbook on the subject for primary care physicians. As a specialist in chronic pain management Dr. Smith has endeavored to “listen” and assist these patients. The book “Is Anyone Listening” published by Dr. M. G. Anderson (The Copy Press, New Zealand, 2005) provides a unique insight into Dr. Smith, her work, and a population of patients who feel that “no one” is listening or interested in managing their legitimate medical problems.
Isadore M. Tarlov (1905-1970) was a neurosurgeon who never forgot he was also a physician. Born in Norwalk, Connecticut he attended Clark University in Massachusetts. As an avid pupil of Robert Goddard, the inventor of the rocket, he became inspired by science. After graduating from Johns Hopkins Medical School in 1930 he was the first neurosurgical resident of Wilder Penfield at the newly founded Montreal Neurological Institute. These experiences led him to understand what was really important in caring for the sick and did his best to communicate his philosophy to his students, as well as his colleagues. In his 1969 text, “The Principle of Parsimony in Medicine” he presented his insightful approach to the practice of medicine based on Oslerian concepts (re: William Osler, Professor of Medicine, Johns Hopkins Hospital). Tarlov’s studies on the anatomy and pathology of the spinal nerves, the arachnoid space, and his description of sacral nerve root cysts (which continue to bear his name) all contributed to making the study of the spine a worthy endeavor. Dr. Tarlov’s introduction of fibrin glue has continued to be a valuable contribution to spine surgery.
Another most important contribution was to provide spine surgeons with the means by which they could operate in a “dry operative field” and thus be able to demonstrate their technical gifts. This was the creation of the knee-chest position, in conjunction with William Cone in Montreal.
This innovative positioning (still in use today) decreased abdominal compression and thus also decreased operative blood loss. Isadore Tarlov’s greatest legacy to his patients was, however, his example of maintaining that the patient’s interests always came first and this was always accompanied by compassion; as well as respect.
Henk Verbiest (1909-1997). It took over 50 years after Gregor Mendel’s demise for trailblazing studies on plants to be “discovered” and serve as the basis for the field of genetics (now known as Mendelian genetics). Henk Verbiest’s identification of lateral spinal stenosis of the lumbar nerve canal was one of the most important single contributions to the field of spine care. Born in Rotterdam, the Netherlands, he started his neurosurgical career at the City and University Hospital in Utrecht in 1942 where he rose to the rank of Professor of Neurosurgery in 1963. Noted for his “impressive capacity for work” Henk Verbiest could usually be found in the operating room during the day and working on his research studies and the Journal Neuro-Orthopedics at night. His first description of lateral spinal stenosis was in 1940 as a contribution to a Festschrift honoring the retirement of his teacher Clovis Vincent. This, and subsequent publications, on lateral spinal stenosis led to this entity being referred to as “the Verbiest Syndrome” by many of his colleagues. It has now been over 50 years since Henk Verbiest first published on lateral spinal stenosis. In 1981 failure to adequately diagnose or treat lateral spinal stenosis was identified as the single most common reason for patients to not do well after back surgery (the “failed back surgery syndrome”). As we enter the 21st century lateral spinal stenosis still remains the most common reason for patients to have a poor surgical result. It is clear that despite the passage of time, many of Henk Verbiest’s spine surgery colleagues still do not have a clue regarding this important pathologic entity. The good news is that Verbiest’s fame will only increase with the passage of time as more individuals recognize his historic work and insights.
Leon Wiltse (1913-2005). It is not uncommon in medicine to encounter academicians demonstrating poor clinical or surgical skills. It is also not uncommon in medicine for technically gifted surgeons to be poor teachers. Lee Wiltse demonstrated that these endowments are not necessarily exclusive and can all be present in a single individual. It may very well have been that Wiltse’s upbringing in North Dakota and education at Northwestern University were partially responsible for these many talents. In addition to this Wiltse also demonstrated that it was also possible to be fair and open-minded regarding one’s own technical innovations as well as those of others. Due to this, his modesty, and his complete integrity, Lee Wiltse gained an exceptional level of credibility among, and appreciation by, his peers. These attributes served him well as a natural leader in the field of spine care. His teaching influence, research and technical advances established an enviable legacy of excellence. It is only a rare surgeon who has also been a savant, philosopher and historian. Leon Wiltse’s inquiring mind led him to explore many important, sometimes unpopular, issues ignored by others. His special interest in spondylolisthesis and studies and publications on the subject of adhesive arachnoiditis due to the neurotoxicity of oil myelography have greatly aided our understanding of why so many surgical patients in the past have ended up as “failed back surgery” syndromes. Because of his work others have been encouraged to develop better diagnostic and therapeutic alternatives for patients thus sparing many from being afflicted with a life of intractable pain and associated disability. When others, after rushing to embrace hemonucleolysis with chymopapain, just as suddenly turned their back on it Lee Wiltse showed how its value could be maintained by more sensible application. As a technically gifted orthopedic surgeon Lee Wiltse was able to appreciate the shortcomings of existing pedicle screw instrumentation systems and to design better implants. He was also able to demonstrate that surgical device manufacturers could deliver a higher quality and also run an ethical business. Few have done more, behind, as well as on, the scene, to show the way for decency in their profession than Lee Wiltse. His departure from the scene has created a void which is unlikely to be filled in the future.