Low Back Pain and Sciatica Due to Protrusion of Intervertebral Discs
Of the several possible causes of low back pain with radiation along the course of the sciatic nerve, protrusion of a lumbar intervertebral disc is one of the most definite pathological conditions which may explain such pain. Although only a small percentage of cases of low back pain and sciatica probably can be explained on this basis, it is of great importance to bear in mind the possibility of such a condition. Within the past four years an increasing number of these cases has been reported in the literature and it would seem that the condition is of fairly frequent occurrence. The recognition of the clinical picture associated with protrusion of a lumbar intervertebral disc and the development of measures for investigating the condition have made it possible to arrive at a definite diagnosis.
The outstanding symptom is pain. This pain is severe in character and frequently is referred to the lateral aspect of the leg. On examination of the patient the following signs are significant: a decrease in lumbar lordosis, limitation of motion in flexion of the lumbar spine, and diminution or absence of an Achilles reflex. Lumbar puncture is an important procedure in diagnosis. In approximately 80 per cent of cases, the total protein content of the cerebrospinal fluid is elevated above the normal limit of 40 mg. per 100 cc. The injection of a contrast medium, such as lipiodol, into the lumbar subarachnoid space followed by roentgen examination demonstrates the protruded disc and completes the diagnosis.
Surgical. . .