The Prolapsed Intervertebral Disc

Neurology lays many claims to being one of the more precise and scientific branches of medicine but, nevertheless, there have been several neurological conditions almost mediaeval in their conceptions. One of these is a group included under the general heading of the neuritides-namely, sciatic and brachial neuritis and neuralgia. There is now a large body of evidence to show that the humoral, atmospheric, rheumatic, infective and other various etiologies have resolved' themselves, on analysis, into problems of anatomy and physics. Pain in the. lower limb roughly corresponding to the course of the sciatic nerve had attracted the attention of clinicians since the work of Contugno in the mid-eighteenth century. Names such as passio ischiadica, sciatic neuralgia, sciatic neuritis, or simply, sciatica, reflect the diversity of etiological theories. As late as I940 Kinnier Wilson defined sciatica as ' pain confined to the field of the sciatic nerve.' In fact, the pain in sciatica is not related to the field of the sciatic nerve. It is a root pain, with a root distribution. Out.of the fog of conjecture, it was Dejerine who first suggested that the ' sciatic syndrome might be produced by lesions of varying pathology, limited to one or more of the spinal roots emerging from the inter-vertebral foramen.' This suggestion was, unfortunately, almost immediately misinterpreted. There became two types of sciatica-high .and low, depending on whether roots or nerve 'were affected. Terms like .radiculitis, funiculitis, trunkitis and plexitis crept into the jargon.