Abstract
The author discussed the diagnosis and treatment of this disease, and reported the endresults of 289 patients who had been treated by posterior approach.
In the diagnosis of the herniation, the complaints, physical signs and neurological examination were considered to be the most important factors, and should be supplemented by radiographic examination. In the radiographic examination, motion of the lumbar vertebrae, especially of the intervertebral joints should be evaluated to obtain an accurate diagnosis. Besides these examinations, the author discussed on the diagnostic value of the phlebographic and myelographic examination.
In the treatment for the herniation, conservative treatment should be done in the initial stage to decrease the inflammatory processes both at the sciatic nerve roots and in the extradural space, because the pain could be elicited by vascular inflammatory process at the nerve roots and in the extradural space, associated with the herniation pressure upon the nerve root. When the pain does not decrease or reccures repeatedly, traction treatment should be done for three weeks. The surgery should be performed when the traction and other conservative treatment are unsuccessful; and in the indication of the surgical treatment, the age and the occupation of the patients should be considered.
The author prefers posterior approach than the anterior approach in the surgical treatment for the herniation. In the surgery, the smaller invasion and the more extended exposure are desirable to make the post-operative sequelae smaller and to remove the herniation more completely. From these standpoints, LOVE's operation and the ‘Partial hemilaminectomy’ seem to be the most favourable technique. The details of these techniques were also described.
In the follow-up results, excellent and good were 87 per cent of the all patients, and 85 per cent returned to their former occupations, however, 41 per cent of the patients have still complained of instability and pain at the low back.
The surgical treatment alone should not be responsible for these complaints, because these complaints are not seldom in the patients who were treated conservatively; moreover, myelography is thought to be one of the cause of these complaints.
