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Burton M. Shinners and Wallace B. Hamby

S ince 1934, when Mixter and Barr 6 elaborated the clinical syndrome of protruded intervertebral discs, low back pain and sciatica, the advances in all phases of the problem have been phenomenal. Varying opinions have been expressed as to the results obtained by treatment and these have ranged in tone from unduly optimistic to needlessly pessimistic. Claim adjustors of at least one insurance company are known to discourage compensation patients disabled by this lesion from seeking surgical relief. In reporting the first 40 cases operated upon for this

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Francis C. Grant

T hat pain in the back and along the sciatic nerve, known to our forebears as sciatica, can be caused by rupture of an adjacent intervertebral disc has introduced a tangible factor into the hitherto uncertain etiology of this distressing condition. Furthermore, the removal of the ruptured disc by a simple operative procedure has been widely heralded as the most certain method of relieving this pain. Prior to 1930, a sufferer from low back pain with sciatica remained in bed until his pain disappeared. Heat, elimination of foci of infection, traction on the leg

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Edgar F. Fincher, Bronson S. Ray, Harold J. Stewart, Edgar F. Fincher, T. C. Erickson, L. W. Paul, Franc D. Ingraham, Orville T. Bailey, Frank E. Nulsen, James W. Watts, Walter Freeman, C. G. de Gutiérrez-Mahoney, Frank Turnbull, Carl F. List, William J. German, A. Earl Walker, J. Grafton Love, Francis C. Grant, I. M. Tarlov, Thomas I. Hoen and Rupert B. Raney

regard to Dr. Lyerly's question on bilateral sciatica: tumors do give bilateral pain more often than protruded intervertebral discs give such pain but the point is not sufficiently reliable to justify positive differential diagnosis. OPERATIVE RESULTS IN INTERVERTEBRAL DISCS This paper appears in this issue of the Journal , page 332. DISCUSSION Dr. James L. Poppen : We have had 12 cases of spinal cord tumor in which the symptoms resembled those of ruptured intervertebral discs. One of the important diagnostic points is that patients with ruptured discs

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William G. Peacher and Robert C. L. Robertson

expressed above and emphasize that routine x-rays are not specific and may not be relied upon for diagnosis. Other reasons demonstrating the value of contrast media are: (1) The possibility of multiple discs. (2) The fact that dorsal and cervical lesions may produce low back pain and sciatica. Camp and Addington 6 found that 31.8 per cent of the cervical tumors, 50 per cent of the tumors of the dorsal spine, and over 83 per cent of those in the lumbar area caused these symptoms. (3) The possibility of establishing an earlier diagnosis of intraspinal pathology before

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M. Hunter Brown and Lester D. Powell

at an earlier date as soon as the danger of incisional necrosis had passed. At the time of discharge on April 6, 1945 the patient was free of headache and sciatica, and incisional tenderness over the sacrum was progressively subsiding. When seen in the Out Patient Clinic early in May she had returned to normal activity and was housekeeping for her family. Fig. 4. The completed suture line showing slight tenting at the right angle at the site of artificial root pouch formation. Pathological Report The sac was a fibrous membrane containing

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Autodermography

A New and Simple Method of Demonstrating the Propagation of Pain and Disorders of Surface Sensibility

Rudolf Černý

. Posterior and lateral views of a patient's own drawing of receding paraesthesia in a left 1st sacral radical syndrome. Our greatest experience in the application of this method is with root pains in so-called lumbago and sciatica, mostly the monoradicular syndromes of the lower extremities. The drawings obtained are in agreement with the dermatome charts of J. H. Kellgren reported by J. Jay Keegan, 2 and not in accordance with the work of Head, Foerster or Déjerine. The patient draws the areas of root pain and on checking these with tests for sensitivity, we find

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Bror Rexed

radiculitis. It seems that one could not exclude the possibility that some such mechanism might be the cause of certain cases of sciatica with obscure etiology. The same might be the case with other inflammatory states of the nerve roots. Fig. 17. Small cyst in right dorsal root from 2nd segment in Case K.224–43. AMH stain; ×65. SUMMARY Around human nerve roots on their entry into the intervertebral foramina there has been found in some cases a pathological thickening and proliferation of the arachnoidea. These circumscribed proliferations resulted in

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Deformities of Dural Pouches and Strictures of Dural Sheaths in the Cervical Region Producing Nerve-Root Compression

A Contribution to the Etiology and Operative Treatment of Brachial Neuralgia

Ragnar Frykholm

D uring the last decade it has become evident that most cases of sciatica are due to some kind of nerve-root compression, usually the result of a herniation of a lumbar intervertebral disk. Lately attention has been drawn also to the intervertebral disks of the lower cervical spine. It has been established that a lateral rupture of a disk in this region may produce a compression of the corresponding nerve root in the intervertebral foramen only, without implication of the cord, thus giving rise to the clinical picture of brachial neuralgia (1943: Semmes and

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Homer S. Swanson and Edgar F. Fincher

leg raising, there were no findings. An epidural saline injection netted very little relief. The patient subsequently returned to work complaining of mild leg pain. Case 2 . A 56-year-old white male was seen in consultation Aug. 27, 1946. His history revealed that following a back strain incurred after lifting a heavy object, he had intermittently experienced low back pain until April, 1944, when, following a second period of trauma, left sciatica appeared. He was operated upon at that time, a lumbar laminectomy being performed and a herniated disc reportedly

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K. Lindblom and Bror Rexed

T he fact that in some cases of sciatica there are no signs of disk herniation at myelography and operative inspection of the spinal canal, prompted Lindblom 4 to make an anatomic study of the incidence of lumbar disk degenerations on cadavers. The specimens were taken from 160 patients of 14 to 87 years of age, regardless of clinical symptoms and cause of death. Among these, 60 nerve compressions were found, most of them by dorso-lateral protrusions against the lateral part of the intervertebral canal, where the nerves with their ganglions cross the