December 2019 Edition. Volume XIX


purebred horses closeup in sunset

According to the book: Stud: Adventures In Breeding (Conley K, Bloomsbury:New York; London 2002) the story of titanium cages began in the Frontier Lounge, Las Vegas in early 1977 when veterinarians Barrie Grant and Pamela Wagner were comparing notes with orthopedic Surgeon George Bagby.  They were discussing the contributions to spinal stabilization being made by neurosurgeon Ralph Cloward in Hawaii.

Cloward started his surgical practice in 1938.  On December 7, 1941 when Pearl Harbor was attacked by the Japanese Cloward rushed to Tripler Army Hospital and spent the next 4 days performing 40 emergency neurosurgical procedures.  During his career Cloward noted that many patients, following surgical discectomy, continued to have problems and decided to stabilize the spine with autogenous iliac bone grafts placed intervertebrally from the posterior approach.  This was inherently a good concept but the bone grafts not infrequently collapsed, fragmented, or displaced causing post-surgical nerve compression and the need for additional surgery.

Bagby was attracted to the Cloward technique because it “junked all the plates and screws that made fusion surgery so cumbersome and gave postsurgical x-rays the look of a messy tool drawer.”  With this in mind Bagby created a perforated stainless steel cylinder (the “Bagby Basket”).  The idea was to impact this cage from the anterior approach and stabilize the cervical spine of horses which would otherwise have to be destroyed.  Arrayed against Bagby and his colleagues were many sages of the horse establishment who believed that nothing could be done for horses with spinal compression.

The chance to prove otherwise first came on May 7, 1977 when the Grant, Wagner and Bagby team successfully operated upon Finelli, a 3 year old colt with equine spinal ataxia due to cervical spinal cord compression. Because the Bagby Basket had to be hammered in place after a dowel was cut out of the spine the technique was not without its risks to the horse. Spinal fractures and death occurred in 20% of the horses operated upon at that time.  It must be kept in mind however that all of these horses would have been destroyed without the Bagby surgery.

Perhaps the greatest challenge to Bagby, and his associates, came in 2000 when they were requested by the Three Chimneys horse farm in Kentucky to attempt the salvage of Seattle Slew who was 26 years old and suffering from cervical osteoarthric degeneration producing spinal cord compression.  By this time the Bagby Basket had been redesigned from a basket to a titanium cage which could be lightly tapped and then screwed into place.  It is interesting to note that this new design was the one approved by the FDA for human use in 1996.  Seattle Slew, with the additional knowledge gained from human titanium cage surgeries survived and went on to enjoying normal function.

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