title: Cervical spine surgery: an historical perspective.
abstract: BACKGROUND
  Continued innovation in surgery requires a knowledge and understanding of historical advances with a recognition of successes and failures.
  
  
  OBJECTIVE
  To identify these successes and failures, we selectively reviewed historical literature on cervical spine surgery with respect to the development of (1) surgical approaches, (2) management of degenerative disc disease, and (3) methods to treat segmental instability.
  
  
  METHODS
  We performed a nonsystematic review using the keywords "cervical spine surgery" and "history" and "instrumentation" and "fusion" in combination with "anterior approach" and "posterior approach," with no limit regarding the year of publication. Used databases were PubMed and Google Scholar. In addition, the search was extended by screening the reference list of all articles.
  
  
  RESULTS
  Innovative surgical approaches allowed direct access to symptomatic areas of the cervical spine. Over the years, we observed a trend from posterior to anterior surgical techniques. Management of the degenerative spine has evolved from decompressive surgery alone to the direct removal of the cause of neural impingement. Internal fixation of actual or potential spinal instability and the associated instrumentation have continuously evolved to allow more reliable fusion. More recently, surgeons have developed the basis for nonfusion surgical techniques and implants.
  
  
  CONCLUSIONS
  The most important advances appear to be (1) recognition of the need to directly address the causes of symptoms, (2) proper decompression of neural structures, and (3) more reliable fusion of unstable symptomatic segments.
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
authors.forename: Alberto
authors.initials: A
authors.lastname: Di Martino
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000266:history / Q000473:pathology / Q000601:surgery; D007593:Joint Instability / Q000601:surgery; D007796:Laminectomy / Q000266:history* / Q000379:methods; D009777:Occipital Bone / Q000601:surgery; D019637:Orthopedic Procedures / Q000266:history* / Q000639:trends; D013123:Spinal Fusion / Q000266:history / Q000295:instrumentation / Q000379:methods