The results of surgery for low back and leg pain due to presumptive prolapsed intervertebral disc.

Abstract

Summary Fifty-six patients who had undergone fifty-seven operations for low back and leg pain thought to be associated with a prolapsed intervertebral disc have been reviewed. Forty-two had only mild residual signs and symptoms or none at all. The patients selected for surgery were those with intractable signs and symptoms which had not improved with conservative treatment, and some were chronic low back invalids. Myelography is a desirable adjunct in some patients when localization or diagnosis is in doubt. In addition to the forty-two patients who had a successful outcome, five patients were improved and five who eventually had recurrences were successful at first. The figures therefore show that some measure of relief resulted from fifty-two out of fifty-seven operations performed. The results of operation for carefully selected patients with presumptive prolapsed lumbar intervertebral disc are good. The operation is expected to relieve leg pain but more than half the patients will continue to have some discomfort or paraesthesiae. More relief from backache occurs than might be expected in view of the pathology and nature of the surgical procedure. Most patients can return to their former occupation even though arduous. Those accustomed to wear low back supports for years are able to stop doing so after surgery. A small proportion of patients with initial successful results develop recurrence of back and leg symptoms. Most subside with conservative treatment and may arise from rupture of adhesions but re-exploration is sometimes necessary. The results after the fenestration operation were not convincingly superior to those after laminectomy. Bearing in mind that the fenestration procedure was usually done on those with clear-cut signs and positive localization, it does not appear that there is anything to be gained by doing this rather more difficult operation.