At the beginning of the 20th century, the development of safer
anesthesia,
antiseptic techniques, and meticulous surgical dissection led to a substantial decrease in operative risk. In turn, the scope of surgery expanded to include elective procedures performed with the intention of improving the quality of life of patients. Between 1908 and 1912, Harvey Cushing performed 3 dorsal
rhizotomies to improve the quality of life of 3 patients with debilitating
neuralgia: a 54-year-old man with "lightning" radicular
pain from
tabes dorsalis, a 12-year-old boy cutaneous
hyperesthesia and spasticity in his hemiplegic arm, and a 61-year-old man with postamputation
neuropathic pain. Symptomatic improvement was seen postoperatively in the first 2 cases, although the third patient continued to have severe
pain. Cushing also removed a prominent spinous process from each of 2 patients with debilitating
headaches; both patients, however, experienced only minimal postoperative improvement. These cases, which have not been previously published, highlight Cushing's views on the role of surgery and illustrate the broader movement that occurred in surgery at the time, whereby elective procedures for quality of life became performed and accepted.