Ralph Bingham Cloward (September 24, 1908 — November 13, 2000) was an American neurosurgeon, best known for his innovations in spinal neurosurgery. Cloward is known for the development of the Posterior Lumbar Interbody Fusion and Anterior Cervical Discectomy and Fusion. Cloward moved from Chicago to Hawaii in 1938, becoming the state's lone neurosurgeon. He is well known for his work treating victims of brain injuries after the Pearl Harbor attack in 1941.
Early life and education
Ralph Cloward was born in Salt Lake City, Utah, in 1908. He schooled at McKinley High School, Honolulu before studying at the University of Utah. He completed his medical education at the Rush Medical School in Chicago. He interned at St Luke's Hospital, Chicago, and attended the University of Chicago under Professor Percival Bailey as a resident in 1938. He designed over 100 surgical instruments which continue to be used today by practicing neurosurgeons.
Posterior Lumbar Interbody Fusion (PLIF)
After William Mixter and Joseph Barr published their famed paper of disk herniation in 1934, discectomy to remove stenosis became the routine procedure. Alternative attempts were to fuse the posterior arch of the spine. In cases of spondylolisthesis, some surgeons had fused the interbody space, but only from an anterior approach. During a posterior discectomy operation in 1940, Cloward noticed a large hole in the remaining annulus fibrosis, 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. Because disk herniation recurred in many cases, Cloward devised to reattempt his posterior interbody fusion procedure, which he did with success. However, as Cloward and later advocates argued, if performed successfully, the PLIF provided better biomechanics and outcomes.
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 Nazareth Hospital 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.
When Cloward published his last paper on PLIF in 1985, he reported a successful fusion rate of over 92%. 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.
Bailey, Badgely and Abbott had been the first to use the technique 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 dowel was taken from a 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.