Ruptured intervertebral disc and sciatic pain.

Within the past fifteen years the medical profession has recognized the existence of a syndrome characterized by low-back and sciatic pain, due to protrusion of a ruptured intervertebral disc with pressure on one or more roots of the lumbosacral plexus. The clinical diagnosis in the typical case presents no particular problem. The localization of the lesion by contrast myelography and the technique of its removal by partial larninectomy have become standard procedures. It appears probable that the trend is toward fusion of the spine, at the time of laminectomy, in an increasing number of these cases. The thesis that every patient should have a spine fusion done at the time of laminectomy is tenable. As operative technique improves, the difficulties of the combined operation tend to disappear, and it seems probable that the combined operation will, in the near future, be the operation of choice for the majority of patients. There is every reason to maintain a conservative attitude toward the operative removal of ruptured intervertebral discs. An operation of this magnitude is not without some risk, and it is not invariably successful. The conscientious surgeon and the average patient will be much happier to have tried conservative treatment for a period of time before resorting to operative interference. The principles of rest and immobilization, adequate sedation during the acute phase of the process, followed by protection of the low back from undue strain, and postural rehabilitation appear to be the essential parts of a conservative regimen.