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[Sciatica. From stretch rack to microdiscectomy].

P Gruber1,2, T Böni3,4

  • 1Klinik für Neurologie, Universitätsspital Zürich, Frauenklinikstrasse 26, 8091, Zürich, Schweiz. philipp.gruber@usz.ch.

Der Unfallchirurg
|November 18, 2015
PubMed
Summary
This summary is machine-generated.

Treatment for discogenic nerve compression has evolved from limited ancient methods to advanced surgical techniques. Microdiscectomy remains the gold standard for lumbar disc herniation, despite the development of minimally invasive options.

Keywords:
DiscectomyHistory of medicineLumber disc herniationSciaticaSpinal surgery

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Area of Science:

  • Spine Surgery
  • Neurosurgery
  • Orthopedics

Background:

  • Historically, treatments for discogenic nerve compression were limited due to poor anatomical and pathophysiological understanding.
  • Early interventions like the stretch rack were non-specific for various spinal disorders.

Observation:

  • The 19th century saw increased anatomical knowledge and surgical advancements, leading to early spinal interventions.
  • In 1908, Oppenheim and Krause performed the first lumbar discectomy but did not identify the exact pathology.
  • Mixter and Barr's 1934 report clarified lumbar disc herniation's mechanism, establishing discectomy as standard therapy.

Findings:

  • Surgical techniques for intervertebral disc issues rapidly advanced post-1934, with continuous refinement.
  • The introduction of the surgical microscope in the late 1960s led to microdiscectomy.
  • Minimally invasive techniques like chemonucleolysis (1964) and percutaneous discectomy (1975) emerged, alongside laser and endoscopic variants.

Implications:

  • Despite evolving minimally invasive procedures, open discectomy, particularly microdiscectomy, is recognized as the current therapeutic gold standard for lumbar disc herniation.
  • Continued innovation in spinal surgery aims to improve outcomes and reduce invasiveness for discogenic conditions.