Clinical Observation on Lumbar Disc Herniation

The commonest cause of low back pain associated with sciatica has been a herniated lumbar intervertebral disc, although there were many other possibilities, since Mixter and Barr reported it in 1934. Fashions in the treatment of the herniated disc have fluctuated widely in recent years. It has long been known that there was a strong tendency to spontaneous recovery. Nevertheless, the early successes with the operative removal of the herniated discs resulted in the Operation being performed with steadily increasing frequency. But the percentage of operative failures also increased steadily, and a conservative reaction soon followed. Our present policy is to reserve operation for a strictly limited number of carefully selected cases. This paper is to give a complete clinical review of 300 cases of herniated discs upon which surgical removal were performed at C.M.C. from 1967 to 1973. The greatest number of disc protrusions occured at the 4th lumbar disc (64%) in our series. There were many cases who had complained of postoperative backache. and it was suggested that the postoperative backache was due to either improper surgical technique such as inadequate exploration of nerve root or misdiagnosis. It was also suggested to preserve stability of the involved vertebral segments as much as possible to minimize postoperative backache, because removal of the disc itself threatened stability of the anterior compartment of the vertebra and improper surgical technique added more loss of stability of the posterior compartment which resulted in segmental instability as a whole and hastened root compression again.