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The Classic. The Treatment of Ruptured Lumbar Intervertebral Discs by Vertebral Body Fusion

1985; Lippincott Williams & Wilkins; Volume: 193; Issue: &NA; Linguagem: Inglês

10.1097/00003086-198503000-00002

1528-1132

Ralph B. Cloward,

Spinal Fractures and Fixation Techniques

Ralph B. Cloward was born September 24, 1908, in Salt Lake City, Utah. His parents were both descendants of original Mormon pioneers. He received his primary school education in Utah, did his undergraduate studies at the Universities of Hawaii and Utah, and graduated with a B.S. degree from the University of Utah in 1930. The first two years of his medical education were spent at the University of Utah. He completed his medical education at Rush Medical College (University of Chicago), graduating in the class of 1934. He served his internship at St. Luke's Hospital, Chicago (1934–35), then completed his neurology and neurosurgical training at Billings Memorial Hospital and the University of Chicago Clinics from 1935 to 1938 under Prof. Percival Bailey. Dr. Cloward started his practice of neurology and neurosurgery in Honolulu, Temtory of Hawaii, in 1938. He was in Honolulu when the Japanese attacked Pearl Harbor on December 7, 1941, and was assigned by the War Department to remain in Honolulu for the duration of the war to treat local injuries and battle casualties transported from the war front. For his services to civilians and the military during the war. he received a commendation from President Franklin D. Roosevelt “over and above the call of duty,” the civilian equivalent of the Congressional Medal of Honor. Dr. Cloward's contributions to neurosurgery are numerous. His main interest, however, rests in the area of the spine. The posterior lumbar interbody fusion (PLIF) was first performed in 1943 and in 1945 was reported to the Hawaii Territorial Medical Association. His first paper on the technique of the operation was published in the Journal of Neurosurgery (1953) and is reprinted as The Classic in this symposium. In 1958, also in the Journal of Neurosurgery, Dr. Cloward published his original operation for treatment of cervical disc disease by anterior discectomy and interbody fusion. This operation is now used by most neurosurgeons throughout the world. Dr. Cloward is an exceptionally skilled and innovative technical neurosurgeon and rightfully deserves the title “Michelangelo of neurosurgery.” Since his original description of PLIF in 1945, few, if any, of his contemporaries have been able to duplicate his results. The very fact that he could perform this difficult procedure in the early 1940s bespeaks his technical genius. By the same token, because of his technical superiority and the excellent results he obtained with his PLIF procedure, only a few surgeons were willing to attempt the operation. Dr. Cloward is also a genius in devising instrumentation and has had over 100 of his instruments cataloged by Codman and Shurtleff. His case load in recent years, which involves over 200 cases a year, requires that he solve the most difficult and challenging of spinal problems; he remains the envy of many younger surgeons. Dr. Cloward's academic associations are extensive. He is Clinical Professor of Neurosurgery, John A. Bums School of Medicine, University of Hawaii, Honolulu. He was visiting professor and head of the Department of Neurological Surgery at the University of Chicago Medical School, Albert M. Billing Hospital, and the University of Chicago Clinics in 1954–55. Over the years, he has been a visiting professor at the University of Oregon Medical School, the University of Southern California at Los Angeles, and Rush Medical College, The Rush Presbyterian-St. Luke's Hospital, Chicago. Since 1956, he has operated and lectured in 37 states of the United States and 41 cities in 27 foreign countries. Dr. Cloward is a fellow of the American College of Surgeons and is certified by the American Board of Neurological Surgeons (1941). He is a member of professional societies the world over. He is an honorary member of the Asian-Australasian Society of Neurological Surgeons and served as guest lecturer at the recent Sixth Congress in Hong Kong. Dr. Cloward has published 83 original articles in national and international medical journals on neurosurgical subjects and is the author of numerous monographs. He has also made three documentary surgical movies, filmed by the famous Hollywood surgical motion-picture photographer Billy Burke, on the subjects of lumbar vertebral body fusion, anterior cervical fusion, and anterior cervical cordotomy. He has recently developed a library of eight videotapes on spinal operations. Dr. Cloward is a 32nd Degree Mason, a member of the Mormon Church, was a playing member of the Honolulu Symphony Orchestra (1926–28), and for one year (1927) was a member of the Royal Hawaiian Hotel Band in Honolulu. He is also a member of the Sons of the American Revolution and the Sons of Utah Pioneers. Behind every great man there is always a strong influencing woman. In Ralph's case, he was fortunate enough to have married Florence Bauer, a charming and gracious lady who presided over many beautiful receptions in their beachfront estate at the tip of Diamond Head. The paradise setting of their home stirs many pleasant memories for those who had the opportunity to visit them. The composition of this symposium with the help of 14 fine contributors has finally legitimized the techniques of posterior lumbar interbody fusion that Dr. Cloward devised over 40 years ago. The delay in its acceptance is not due to any inadequacy of conception but rather to the fact that Dr. Cloward was so far ahead of his time in technical skill that he made others appear inferior. PAUL M. LIN, M.D.