Wednesday's Child: An Adult Survivor of Childhood Sexual Abuse

This paper examines some long-term residues of childhood sexual abuse, drawing on relevant literature and focusing on a case study of a female patient seen three times weekly over a period of two years. I have attempted to explore the particular syndrome that is characteristic of those who have been sexually violated in childhood, by adults who also assume a position of trust. The clinical work provided evidence of the link between early maternal deprivation and vulnerability to abuse and I have illustrated my observations by emphasising the emotional context in which the abuse occurred. Specific difficulties of working with this patient are considered, including problems arising in the transference and the compulsion to repeat the traumatic experience both within and outside the therapeutic situation.     

A modified muscle-splitting approach to the lumbosacral spine.

A modification of a previously reported extraperitoneal approach to the lumbosacral spine is described. The external oblique muscle is split in line with its fibers. The anterior and posterior layers of the rectus sheath are divided vertically medial to the semilunaris without splitting the internal oblique and underlying transversalis abdominus muscles. This allows an extensile retroperitoneal approach suitable for exposure of both the mid-lumbar and lumbosacral spine. There have been no complications of this approach with its use in over 50 patients undergoing anterior lumbar interbody fusion.