Preincisional Localization: An Overlooked Contribution by Ralph Bingham Cloward.

Preincisional localization has become ubiquitous within spinal neurosurgery and has served as the foundation for modern minimally invasive surgery techniques. Dr. Ralph Bingham Cloward, renowned for his contributions to the field of spinal fusion, was a strong advocate and early adopter of diskography. In fact, Cloward credited cervical diskography for inspiring his anterior approach to the cervical disk. In his landmark 1958 article on what is now known as anterior cervical diskectomy and fusion, Cloward commented on a case of wrong-level surgery that motivated him to implement a standardized technique for spinal level localization with the patient under anesthesia in the operating room before skin incision. We trace the origins of the use of preincisional radiographs to localize the pathologic level at the time of diskectomy and highlight this original contribution by Cloward.