Two hundred and forty-eight patients with sciatica were treated during the period from 1946 to June, 1954 Ofall the patients, 60 cases were treated conservatively with various combinations of medication, corsets, massage, short wave diathermy, bed rest, pelvic traction or manipulation. The remaining 188 cases were operated upon, 151 cases were found to have intervertebral disk herniation at the time of operation.
The postoperative results were analysed from the following view points.
(1) Follow up results after removal of intervertebral disk herniation.
Excellent (No complaints and restored full working ability) ……62R
Good (Complaints relieved, but having occasional discomfort and diminished working ability) ……23%
Fair (Unrelieved) ……13%
Poor (Worse) ……1%
(2) Low back complaints.
Five criteria were assumed to asses the degree of the back complaints. a) Easy fatiguability, b) Disability to walk over 4km, without feeling of weakness or heavy sensation in the lumbar region, c) Disability to stand on the semi-sitting position for over 30 minutes. d) Disability to lift a heavy load, e) Uncomfortable sensation in the lumbar region. The low back complaints are graded as (-), when the patients have none of the criteria. These are graded as (+), when the patients have one or two of the criteria, and are graded as (++), when the patients have more than three of them.
The low back complaints (-), (+) and (++) were noted in 49%, 26% and 25% of the 100 surveyed patients respectively.
(3) Occupation after operation.
Eighty-eight per cent of the patients returned to their former occupations and 7% of them changed their works from heavy to light ones. The rest of 3% (three cases) remained unemployed for the reasons that the first case had difficulty in finding job, the second had no mind to work and the last were suffered from postoperative sequelae (thrombophlebitis femoris).
(4) Sequelae after surgical treatment.
Physical examinations were made on 32 patients received surgical treatment and revealed that 12 cases of them had postoperative sequelae.
Peroneal nerve palsy …… 1 case
Sensory disturbance (hypaesthesia) …… 2 cases
Limited straight leg raising and tenderness on pressure of sciatic nerve and its arborizations …… 4 cases
Tenderness on pressure of the sciatic nerve and its arborization …… 5 cases
It is of myy opinion that the numbers of 32 cases are not large enough for valid statistical deducation regarding the surgical results of 113 patients, but as far as the results obtained from this small group of the patients are concerned, these are satisfactory ones.
(5) Frequency of postoperative low back complaints in relation to the kind of occupation.
Heavy workers such as truck drivers, carriers, farmers or lathe men were more liable to suffer from the postoperative low back complaints than light workers such as teachers, students on office men.
Conclusion;
Careful selection of patients for surgery is essential. Our indications for surgery are as follows:
1) Conservative treatment by hospitalization and absolute bed rest over a period of more than three weeks fail to bring improvement.
2) Recurrences sciatica and low back pain are frequent.
3) Limited straight leg raising is persistent.
4) Sensory or motor disturbance is persistent.
Laborers engaged in heavy labor should be advised not to receive disk surgery because they complain of postoperative low back pain very often after surgery.
Disk excision are done by osteoplastic partial hemilaminectomy (Kondo) on osteoplastic partial laminectomy (Love). Moreover, if there is marked instability in the affected part of spine the spine, fusion may be necessary.
抄録全体を表示