Clinical and Neurological Aspects of Low Back and Sciatic Pain

Abstract

THE patient with intractable low back and sciatic pain always has been a problem to the physician. Lumbago and sciatica are ancient conditions; Hippocrates is known to have advised the use of the actual cautery in the treatment of patients afflicted with these conditions. The use of the actual cautery, at least by many of the ancient and medieval physicians, seems to have been reserved for the treatment of those conditions for which the physician had very little else to offer; and use of the hot iron probably accomplished the purpose of allowing the physician to feel that he was doing something in a difficult situation, at the same time terrifying the patient to such extent that he stayed away from the physician and refrained from bothering him with his troublesome complaints. To-day, physicians are more fortunate in that they can offer the patient suffering from this painful condition more effective methods of treatment. Low back and sciatic pain, however, are still responsible for a tremendous economic loss each year, so that accurate diagnosis of the condition and proper treatment of the patient are important. Recently the anatomy, physiology, and pathology of the various structures composing the lumbosacral region of the spinal column and pelvis have been carefully studied in the hope of determining the cause of this distressing symptom of pain in the lower part of the back and along the course of the sciatic nerve and of finding suitable treatment for the condition responsible for it. It is interesting to note that several investigators, approaching the problem from different aspects, have found causes for this pain which have sufficed to satisfy the investigators and their followers that they have located the source of the trouble in at least some cases. It is impossible in this brief period of time to mention all these various contributions and their originators. But I may call attention, in passing, to the work of Ghormley on what is called the “facet syndrome” (arthritis of the facets); of Ober on sciatic pain due to tense fascia lata; of Towne and Reichert; of Spurling and associates; and of Brown on treatment of hypertrophy of the ligamenta flava by compression of the nerve root; of Goldthwait, and Middleton and Teacher, and Mixter and Barr, and Hampton, and Robinson, and Love, Camp, and the author (2, 3, 9, 10, 11, 18), not to menbon many othhders, on te prouction of low back and sciatic pain by posterior protrusion of an intervertebral disc; and also of Steindler on the production of low back and sciatic pain by irritation of the posterior divisions of spinal nerves originating in pathologic processes in muscles and ligaments; and of Gratz on the production of this type of pain by fascial adhesions. Proper evaluation of all these so-called “syndromes” will take many years.