Sciatica: a historical perspective on early views of a distinct medical syndrome

The History behind the Discovery of Root Tension Signs and the Invention of the Lumbar Discectomy Surgery

Introduction Sciatica, a common affliction, has been a well known scourge throughout recorded history of mankind and finds a mention in the writings of Hippocrates [1]. The clinical root tension signs were described in the late 19th century, and their discovery preceded the development of surgical techniques for this disorder. As surgeries became safe at the beginning of the 20th century, surgeons incorrectly diagnosed the pathology as cartilaginous tumors in these operated patients. Finally, by the 1930s, they had started connecting the dots and discovered that lumbar disc herniation was responsible for the clinical syndrome of sciatica. In this report, we trace an interesting history from the discovery of the root tension signs for sciatica to the invention of lumbar discectomy surgery for a herniated lumbar disc. There is a great deal of confusion in the eponymous naming of the passive SLR test in various textbooks. Bruce Reider’s The Orthopaedic Physical Examination, a book popular among orthopedic residents, describes the forced dorsiflexion maneuver as the Laségue’s test [2]. While Todd Albert’s Physical Examination of the Spine describes the same maneuver as Bragard’s test [3]. Most textbooks, however, refrain from using eponymous names to describe these neurological signs, especially because there is so much confusion about them. Nevertheless, the medical history behind these root tension signs is no less fascinating. Many attribute the first description of the passive SLR to Ernst Charlie Laségue (Fig. 1), who was a Professor of Medicine in Paris. In his 1864 paper, he described a syndrome of radicular pain which sometimes was associated with muscle atrophy [4]. However, in this paper, he did not describe the leg raising test. Robert Wartenberg, the owner of a few eponymous signs and syndromes himself, worte in 1956: “it is highly embarrassing to state the plain fact that all authors who quoted Lasègue’s article of 1864 as a source of Lasègue’s sign did not

A history of lumbar disc herniation from Hippocrates to the 1990s

In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with lumbar disc herniation. In this era, use of discectomy surgery increased rapidly. Even patients with very early symptoms were offered surgery. Later work, especially by Weber and Hakelius, showed that many patients with lumbar disc herniation would improve without surgical intervention. In the ensuing decades, the debate over operative indications and timing continued, reaching another pivotal moment with the 2006 publication of the initial results of Spine Patient Outcomes Research Trial.

Newer insights to the neurological diseases among biblical characters of old testament

Many people over the years have studied the Bible from a medical point of view offering diagnoses for the symptoms and signs that appear to have afflicted numerous individuals in the Bible. We review the biblical characters in the Old Testament and offer newer insights to their neurological diseases. We first look at the battle between Goliath and David. Interestingly, Goliath probably suffered from acromegaly. We propose autism as a diagnosis for Samson which would precede the first known case of autism by centuries. Isaac was a diabetic, and he probably had autonomic neuropathy. Few verses from the books of I Samuel, Psalms, and Ezekiel reveal symptoms suggestive of stroke. Jacob suffered from sciatica, and the child of the Shunnamite woman in II Kings had a subarachnoid hemorrhage. These instances among others found in the Old Testament of the Bible offer newer insights on the history of current neurological diseases.

Hydrocephalus and its treatment according to Rhazes

The renowned medieval Persian physician Rhazes was an early proponent of experimental medicine. Rhazes made fundamental and enduring contributions to medicine and to other scientific fields. He wrote over 200 scientific books, more than half of which concerned medicine. He was well versed in Persian, Greek, and Indian medical knowledge, and made numerous contributions to the medical field through his own observations and discoveries. He was also a pioneer in the field of neurosurgery and, as he was predominantly a pediatrician, he dealt with the subject of hydrocephalus. A large part of his medical tome, al-Hawi, deals with head-related disorders including the hydrocephalus. Although he did not introduce novel concepts of hydrocephalus and its management, by combining the different approaches of experienced scholars he endeavored to improve treatment and knowledge of this problematic disease.