The causes of unsatisfactory results from the operative treatment of lumbar disc lesions.

The exact place and value of operation in the treatment of lesions of the lower lumbar intervertebral discs is still the subject of much unprofitable controversy. It is clear and has been accepted that almost all patients recover partly or completely after conservative treatment alone. There has, however, been no general agreement about the exact indications for operative treatment, about the percentage of patients who require operation, or about the results which may be expected after surgical intervention ; nor have these problems been much clarified in recent discussions. This uncertainty concerning an important contribution to the treatment of a common and disabling condition is surprising. Removal of diseased lower lumbar discs has been practised for more than fifteen years-ample time to allow a critical appraisal of the procedure. Nevertheless it is probably true to say that most medical practitioners in this country regard the surgical treatment of a “ prolapsed disc “ as a rather speculative measure, only to be advised as a last and somewhat desperate resort. It is true that operation is not uniformly successful. In the recorded series anything between 5 and 40 per cent of unsatisfactory results have been reported, and every surgeon dealing with large numbers of these lesions meets with disappointments from time to time. In the present writer’s view both too much and too little attention is paid to these unsuccessful operations : too much attention in the sense that the comparatively small percentage of poor results is used on argument that surgery is never indicated in this condition, without regard for the many patients who are completely relieved by operation after conservative treatment has failed ; and too little attention in that not enough time has been spent in analysing the causes of failure. It may be, of course, that a certain proportion of disc lesions, especially in the late stages, are not amenable to surgery, and that in such cases poor results are inevitable. The writer does not believe this to be so. This paper is based on the findings in patients with ‘ ‘ failed “ operation for disc lesions seen at various hospitals. The series included Service patients and civilians from all over the country; they had been operated on by many different surgeons. The writer considers that it is possible to determine the cause of failure in most instances, and that the causes may be classified.