CASE OF LUMBO-SACRAL INTER-

VERTEBRAL DISC HERNIATION

CAUSING ' SCIATICA'

By G. P. CHARLEWOOD, m.b., ch.B., m.r.c.o.g.

Civil Surgeon, Ajmer-Merwara, Ajmer

Considerable argument has taken place in recent years in the medical press as to the fre-

quency of herniation of the nucleus pulposus of the lumbar intervertebral discs as a cause of

pain along the course of the sciatic nerve.

Some authorities such as Dandy believe that with few exceptions sciatic pain is always due to such a ruptured intervertebral disc. Most others would be unwilling to go as far as this, but nevertheless it is becoming increasingly clear from the voluminous literature on the sub-

ject that herniation of the nucleus pulposus is a common cause of sciatic pain and must be seriously considered in every persistent case.

It is worth remembering too that, in more

severe lesions, hyperesthesia in the ' saddle' area may develop, bladder function may become impaired, and paresis of one or both

legs may occur. In about half the cases a

history of injury may be elicited.

Case history The patient, a policeman, aged 30 years, started

getting pain along the course of the sciatic nerve

some eight months previously. It was of a fairly severe nature making it impossible to carry on his duties as a policeman or even to walk about without pain. There was a history of an injury two years previously when he fell from a bicycle and injured his ankle. He did not remember any injury to his spine at the same time. Various types of treatment had been given to the patient for sciatica, such as massage, diathermy, manipulation of the sacro-iliac joint, injec- tions of saline or novocaine into the nerve or its

surroundings, etc. None was successful.

On examination, there was wasting of the gluteal and thigh muscles, and tenderness along the course

of the sciatic nerve. There were no abnormal neurol-

ogical signs. The patient seemed genuinely keen to

get well and back on duty as lie was afraid of being passed over for promotion, so it was considered that the presence of a psychological basis of the symptoms could be excluded. Further investigations were there- fore undertaken to try to establish the nature of the lesion. A plain x-r&y photograph of the lumbar vertebrae showed nothing except a narrowing of the lumbo-sacral intervertebral disc which is thought to be of some diagnostic significance in herniation of the disc material. A lumbar puncture showed no abnormality, and the Queckenstedt test showed no spinal block. 30 c.cm. of air were injected into the spinal canal and

an x-ray plate (air myelograph) of the lumbar region was taken, but nc definite evidenco of any disc protrusion was found. ,

In spite of these negative findings the persistence of pain and the keenness of the patient to have some- thing done seemed to warrant a.u exploratory laminec- tomy. This was done in the usual wajr, the anterior wall of the canal being visualized by retracting the unopened dura mater to the left. A definite hernia- tion of the disc material, about the size of a pea, was seen at the Jumbo-sa^^l joint, and was removed easily by blunt dissection. '

On coming round from the anaesthetic, the patient stated that hi^ old pain had completely gone, and though he hid some unexplained tenderness in the calf muscles, this steadily decreased and was gone within a fortnight of his operation.

The only justification for publishing a single case of disc herniation is to help draw atten- tion to what is undoubtedly a common but in- sufficiently recognized lesion.

My thanks are due to Rai Bahadur Suraj Narain for his co-operation.