253:, and it occurred to him that this void could be filled with a piece of bone. But the patient suffered a pulmonary embolism on the tenth post-operative day, and died. This complication led Cloward to abandon his idea until 1943. Because disk herniation recurred in many cases, Cloward devised to reattempt his posterior interbody fusion procedure, which he did with success. Cloward soon became an expert of the procedure, and began to advocate for its use. In 1945, he presented the technique before the Hawaiian Territorial Medical Association, and at the annual meeting of the
311:
that Ralph's innovative talents and pioneering efforts to establish anterior cervical and posterior lumbar interbody fusion plus the numerous instruments he devised was just cause to honor him in perpetuity by bestowing an award upon neurosurgeons from around the world who also exemplified such capacity for epochal innovation and pioneering application. In 2002, the
Society established the award with the gracious assistance of the surviving Cloward family.
310:
Cloward was a member of the
Western Neurosurgical Society for 40 years and served as its President in 1975. After his death in 2000, a number of Society members were desirous of creating an award in his name which would include a medal akin to the Cushing Medallion awarded by the AANS. It was felt
294:
Bailey, Badgely and Abbott had been the first to use the technique however, the first report was provided by
Robinson and Smith, in 1955. Cloward's technique differed from the other surgeon's in that he used a large dowel graft, as opposed to the strut graft that the others used. His idea for this
224:
Cloward's pioneering contributions encompass many areas of neurosurgery, but his enduring interest was the spine, where he devised three major operations. He first performed the posterior lumbar interbody fusion successfully in 1943, reporting it in the
Hawaiian Territorial Medical Association in
277:
in
Philadelphia in 1981 and the first PLIF Symposium was held in Temple Hospital in 1983. By this time, the procedure had garnered many advocates. In later years, when pedicle screw and interbody cage instrumentation became widespread, the PLIF became the most popular method of lumbar fusion.
290:
Other than the PLIF, Cloward is well known as being an innovator in the anterior approach to cervical fusion. In the mid 1950s, techniques for anterior approach to cervical fusions were developed by four groups simultaneously; Carl
Badgley, Leroy Abbott and Robert Bailey at the University of
225:
1945 and publishing it in the
Journal of Neurosurgery in 1953. His unique approach for treating hyperhydrosis was reported in 1957. Independently, he conceived an anterior approach to the cervical spine, devised instruments for its implementation, and published his classic paper in the
281:
When
Cloward published his last paper on PLIF in 1985, he reported a successful fusion rate of over 92%. Cloward was the first to perform PLIF, both unsuccessfully and successfully and the first to publish a large patient series.
272:
Over time, after refining the technique and advocating its merits with publications and lectures, the PLIF became respected. With the help of a few other surgeons, including Paul Lin, the first PLIF Workshop was held at
291:
Michigan, by Robert
Robinson and George Smith at Johns Hopkins University, by Albert Dereymaeker and Joseph Mulier in France and by Cloward in Honolulu. None were aware of the work of the others at the time.
298:
Though not the first to perform or publish the procedure, his standing in the neurosurgical field at the time enhanced its early popularity. Like the PLIF, ACDF is now a popular method of spinal fusion.
261:) in 1947. However, at the Harvey Cushing Society meeting, reception to the technique was critical. At the time, neurosurgeons were apprehensive about fusion techniques, which were traditionally an
295:
dowel was taken from an modification made by Ben
Wiltberger to Cloward's PLIF operation, who had used dowels in place of Cloward's bone pegs. Cloward published his work on the subject in 1958.
265:
method. Moreover, the procedure was very challenging, and was associated with complications. However, as Cloward and later advocates argued, if performed successfully, the PLIF provided better
229:
on anterior cervical discectomy and fusion in 1958. He designed over 100 surgical instruments which continue to be used today by practicing neurosurgeons.
1253:
1065:
258:
406:
167:
142:
to Hawaii in 1938, becoming the state's lone neurosurgeon. He is well known for his work treating victims of brain injuries after the
1161:
Robinson, Robert A.; Smith, George W. (1955). "Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome".
738:"The Treatment of Ruptured Lumbar Intervertebral Discs by Vertebral Body Fusion: I. Indications, Operative Technique, After Care"
307:
Throughout his career, he educated the international community of neurosurgeons in the performance of the operations he devised.
250:
159:
135:
1041:
1258:
182:
He began his practice of neurosurgery in the Territory of Hawaii in 1938. He was the only American neurosurgeon in the
206:
214:
237:
After William Mixter and Joseph Barr published their famed paper of disk herniation in 1934, discectomy to remove
1248:
1243:
537:
Briggs, Henry; Milligan, Paul (1944). "CHIP FUSION OF THE LOW BACK FOLLOWING EXPLORATION OF THE SPINAL CANAL".
183:
565:
241:
became the routine procedure. Alternative attempts were to fuse the posterior arch of the spine. In cases of
221:. He is the author of numerous papers and book chapters and has lectured and operated in many nations.
1069:
716:
Cloward, Ralph B (1982). "History of PLIF - Forty Years of Personal Experience". In Lin, Paul M (ed.).
737:
60:
218:
1147:
249:. During a posterior discectomy operation in 1940, Cloward noticed a large hole in the remaining
226:
162:, Honolulu before studying at the University of Utah. He completed his medical education at the
421:
254:
143:
793:"The Classic: The Treatment of Ruptured Lumbar Intervertebral Discs by Vertebral Body Fusion"
198:
171:
85:
1036:. Manjila, Sunil V.,, Mroz, Thomas E.,, Steinmetz, Michael P. Edinburgh. 11 September 2018.
1238:
1233:
333:
Maiti, Tanmoy K.; Konar, Subhas K.; Bir, Shyamal C.; Kalakoti, Piyush; Nanda, Anil (2016).
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832:"The early days of neurosurgery as I remember them, with emphasis on disc surgery"
238:
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962:
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384:
1002:"News Notes: International Posterior Lumbar Interbody Fusion Symposium".
590:
498:"Rupture of the Intervertebral Disc with Involvement of the Spinal Canal"
402:
190:. In connection with the attack on Pearl Harbor in 1941, he performed 44
262:
191:
197:
His academic accomplishments include visiting professorships at the
246:
1142:
285:
139:
245:, some surgeons had fused the interbody space, but only from an
1182:"Intervertebral Body Fusion By the Use of Posterior Bone Dowel"
451:"The anterior approach for removal of ruptured cervical disks"
232:
422:"Storied island neurosurgeon Ralph B. Cloward dies at 92"
122:(September 24, 1908 — November 13, 2000) was an American
1088:"Stabilization of the cervical spine by anterior fusion"
174:
under Professor Percival Bailey as a resident in 1938.
1092:
The Journal of Bone and Joint Surgery. American Volume
883:
The Journal of Bone and Joint Surgery. British Volume
332:
335:"Ralph Bingham Cloward (1908–2000): Spine Polymath"
1225:
496:Mixter, William Jason; Barr, Joseph S. (1964).
536:
286:Anterior Cervical Discectomy and Fusion (ACDF)
130:. Cloward is known for the development of the
1160:
1085:
259:American Association of Neurological Surgeons
879:"Lumbo-Sacral Arthrodesis After Laminectomy"
931:"Posterior Lumbar Interbody Fusion Updated"
149:
1186:Clinical Orthopaedics and Related Research
1179:
1064:: CS1 maint: location missing publisher (
935:Clinical Orthopaedics and Related Research
797:Clinical Orthopaedics and Related Research
790:
495:
213:. He was Professor of Neurosurgery at the
1138:"Interviewed at the AANS by Roy C. Selby"
1136:Cloward, Ralph Bingham (April 29, 1991).
894:
720:. Springfield: CC Thomas. pp. 58–70.
589:
513:
1254:John A. Burns School of Medicine faculty
233:Posterior Lumbar Interbody Fusion (PLIF)
1135:
928:
829:
735:
715:
563:
539:The Journal of Bone & Joint Surgery
448:
385:"A neurosurgeon remembers Pearl Harbor"
382:
136:Anterior Cervical Discectomy and Fusion
1226:
1163:Bulletin of the Johns Hopkins Hospital
1086:Bailey, R. W.; Badgley, C. E. (1960).
876:
791:Lin, Paul M; Cloward, Ralph B (1985).
659:
1131:
1129:
1081:
1079:
982:
980:
924:
922:
731:
729:
727:
711:
709:
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703:
620:
419:
623:"An Operation for Spondylolisthesis"
444:
442:
378:
376:
328:
326:
324:
126:, best known for his innovations in
986:
420:Morse, Harold (November 13, 2000).
13:
1126:
1076:
977:
919:
724:
700:
14:
1270:
989:Posterior Lumbar Interbody Fusion
718:Posterior Lumbar Interbody Fusion
439:
373:
321:
207:University of Southern California
177:
132:Posterior Lumbar Interbody Fusion
1198:10.1097/00003086-196400350-00007
1180:WILTBERGER, BENJAMIN R. (1964).
1150:from the original on 2021-12-13.
1104:10.2106/00004623-196042040-00001
947:10.1097/00003086-198503000-00003
848:10.1097/00006123-198508000-00024
809:10.1097/00003086-198503000-00002
662:"Treatment of Spondylolisthesis"
570:BJS (British Journal of Surgery)
215:John A. Burns School of Medicine
158:, Utah, in 1908. He schooled at
1173:
1154:
1024:
995:
870:
823:
784:
383:Cloward, Ralph Bingham (1976).
302:
653:
614:
557:
530:
489:
455:Journal of Neurosurgery: Spine
413:
1:
639:10.1016/s0140-6736(00)85724-4
314:
1018:10.1016/0090-3019(83)90263-X
170:, Chicago, and attended the
7:
1259:Rush Medical College alumni
166:in Chicago. He interned at
10:
1275:
896:10.1302/0301-620x.37b2.208
754:10.3171/jns.1953.10.2.0154
736:Cloward, Ralph B. (1953).
515:10.3171/jns.1964.21.1.0074
351:10.1016/j.wneu.2015.06.061
154:Ralph Cloward was born in
991:. Springfield: CC Thomas.
929:Cloward, Ralph B (1985).
877:Adkins, E. W. O. (1955).
830:Murphey, Francis (1985).
660:Mercer, W. (1936-11-07).
449:Cloward, Ralph B (2007).
109:
105:Innovative spinal surgery
101:
91:
77:
67:
49:
28:
21:
1033:Lumbar interbody fusions
678:10.1136/bmj.2.3957.945-b
564:Capener, Norman (1932).
467:10.3171/spi.2007.6.5.496
150:Early life and education
742:Journal of Neurosurgery
502:Journal of Neurosurgery
227:Journal of Neurosurgery
1249:American neurosurgeons
582:10.1002/bjs.1800197505
255:Harvey Cushing Society
61:Queen's Medical Center
1244:20th-century surgeons
1068:) CS1 maint: others (
219:University of Hawaiʻi
199:University of Chicago
172:University of Chicago
138:. Cloward moved from
120:Ralph Bingham Cloward
86:University of Chicago
23:Ralph Bingham Cloward
16:American neurosurgeon
987:Lin, Paul M (1982).
621:Burns, B.H. (1933).
203:University of Oregon
160:McKinley High School
144:Pearl Harbour attack
43:Salt Lake City, Utah
566:"Spondylolisthesis"
211:Rush Medical School
164:Rush Medical School
128:spinal neurosurgery
1005:Surgical Neurology
390:Surgical Neurology
339:World Neurosurgery
168:St Luke's Hospital
82:University of Utah
72:Doctor of Medicine
39:September 24, 1908
1043:978-0-323-49741-1
672:(3957): 945–946.
426:The Star Bulletin
275:Nazareth Hospital
247:anterior approach
243:spondylolisthesis
117:
116:
53:November 13, 2000
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1012:(4): 399. 1983.
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251:annulus fibrosis
56:
38:
36:
19:
18:
1274:
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828:
824:
789:
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734:
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658:
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619:
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576:(75): 374–386.
562:
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535:
531:
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447:
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428:
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381:
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331:
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184:Pacific theater
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78:Alma mater
63:
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40:
34:
32:
24:
17:
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5:
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1125:
1098:(4): 565–594.
1075:
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1023:
994:
976:
941:(193): 16–19.
918:
889:(2): 208–223.
869:
822:
783:
748:(2): 154–168.
723:
699:
652:
633:(5728): 1233.
613:
556:
545:(1): 125–130.
529:
488:
461:(5): 496–511.
438:
412:
372:
319:
318:
316:
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287:
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269:and outcomes.
234:
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179:
178:Medical career
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156:Salt Lake City
151:
148:
115:
114:
113:Florence Bauer
111:
107:
106:
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102:Known for
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57:(aged 92)
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1192:(35): 69–79.
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861:
857:
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849:
845:
841:
837:
833:
826:
818:
814:
810:
806:
803:(193): 5–15.
802:
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751:
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397:(6): 319–22.
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1026:
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842:(2): 370–2.
839:
836:Neurosurgery
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508:(1): 74–81.
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431:November 10,
429:. Retrieved
425:
415:
405:– via
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309:
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303:Later career
297:
293:
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280:
271:
267:biomechanics
236:
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196:
192:craniotomies
188:World War II
181:
153:
124:neurosurgeon
119:
118:
96:Neurosurgeon
55:(2000-11-13)
1239:2000 deaths
1234:1908 births
345:: 562–567.
194:in 4 days.
1228:Categories
1052:1053986677
627:The Lancet
315:References
263:orthopedic
92:Occupation
35:1908-09-24
1206:0009-921X
1112:0021-9355
1060:cite book
955:0009-921X
905:0301-620X
856:0148-396X
817:0009-921X
762:0022-3085
686:0959-8138
647:0140-6736
608:221531875
600:1365-2168
551:0375-9229
524:0022-3085
475:1547-5654
359:1878-8750
257:(now the
146:in 1941.
68:Education
1169:: 233–4.
1148:Archived
1120:13848906
971:37171110
913:14381464
778:46559271
770:13035484
694:71571608
483:17542522
367:26151875
239:stenosis
1214:4873303
1143:YouTube
963:3971616
864:3897894
217:at the
186:during
140:Chicago
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209:, and
110:Spouse
967:S2CID
774:S2CID
690:S2CID
604:S2CID
1210:PMID
1202:ISSN
1116:PMID
1108:ISSN
1096:42-A
1070:link
1066:link
1048:OCLC
1038:ISBN
959:PMID
951:ISSN
909:PMID
901:ISSN
887:37-B
860:PMID
852:ISSN
813:ISSN
766:PMID
758:ISSN
682:ISSN
643:ISSN
596:ISSN
547:ISSN
520:ISSN
479:PMID
471:ISSN
433:2020
399:PMID
363:PMID
355:ISSN
134:and
50:Died
29:Born
1194:doi
1100:doi
1014:doi
943:doi
939:193
891:doi
844:doi
805:doi
801:193
750:doi
674:doi
666:BMJ
635:doi
631:221
586:hdl
578:doi
510:doi
463:doi
407:NLM
347:doi
1230::
1208:.
1200:.
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