Nerve-stretching in the 19th century

Operative nerve-stretching was first described in 1872 to relieve incurable pain from sciatica and tabes dorsalis. It became popular for 20 years and numerous articles were published on the subject. It had many complications but relief was only transient and, consequently, it fell into disuse. This paper analyses the literature, contemporary views on the benefits of nerve stretching and its influence on more recent neurological practice.

Rheumatic diseases in the Corpus Hippocraticum

Medicine of V and IV centuries B.C. attested in the Corpus Hippocraticum ascribes all diseases to the rheuma, i.e. the flux of humours into the body. This flux produces not only the rise of cold, hoarseness, cough, reddening, dropsy, but also arthritis, sciatica, gout.

The first Anatolian contribution to treatment of sciatica by Serefeddin Sabuncuoglu in the 15th century

Serefeddin Sabuncuoglu was an early 15th century surgeon in Anatolia. His masterpiece entitled Cerrahiyetül Haniye (Imperial Surgery) is the first illustrated surgical textbook in the Turkish Islamic literature of the Ottoman era Anatolia. It is the first written medical-surgical work in Anatolian history and it covers the treatment of more than 40 illnesses, which range from hydrocephalus to sciatica. This study aims to investigate the contribution of Anatolia to neurosurgery through Sabuncuoglu's treatment of sciatica, a problematic and common illness.

Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management

Radicular pain in the distribution of the sciatic nerve, resulting from herniation of one or more lumbar intervertebral discs, is a frequent and often debilitating event. The lifetime incidence of this condition is estimated to be between 13% and 40%. Fortunately, the majority of cases resolve spontaneously with simple analgesia and physiotherapy. However, the condition has the potential to become chronic and intractable, with major socio-economic implications. This review discusses the history, epidemiology, pathophysiology, and natural history of sciatica. A Medline search was performed to obtain the published literature on the sciatica, between 1966 and 2006. Hand searches of relevant journals were also performed. Epidemiological factors found to influence incidence of sciatica included increasing height, age, genetic predisposition, walking, jogging (if a previous history of sciatica), and particular physical occupations, including driving. The influence of herniated nucleus pulposus and the probable cytokine-mediated inflammatory response in lumbar and sacral nerve roots is discussed. An abnormal immune response and possible mechanical factors are also proposed as factors that may mediate pain. The ongoing issue of the role of epidural steroid injection in the treatment of this condition is also discussed, as well as potential hazards of this procedure and the direction that future research should take.

A brief history of sciatica

STUDY DESIGN

Historical review.

OBJECTIVES

Appraise history of concept of sciatica.

SETTING

Europe.

METHODS

Selected, original quotations and a historical review.

RESULTS

Evolution of ideas from hip disorders, through interstitial neuritis.

CONCLUSION

Current concepts of discogenic sciatica.

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

The authors offer a brief overview of early theories and treatments of sciatica. Tracing medical traditions through early Greek, Roman, and Eastern epochs, the authors demonstrate the slow sequential steps that were required to delineate this disease as a uniquely human affliction.

The “tract” of history in the treatment of lumbar degenerative disc disease

In this paper past, present, and future treatments of degenerative disc disease (DDD) of the lumbar spine are outlined in a straight forward manner. This is done to review previous knowledge of the disease, define current treatment procedures, and discuss future perspectives. An analysis of a subject of this magnitude dictates that one describes as accurate a history as possible: an anatomical/historical “tract” with emphasis on all possible deviations.

Although spinal disorders have been recognized for a long time, the view of DDD as a particular disease entity is a more recent development. In this paper, the authors attempt to outline the history of DDD of the lumbar spine in an unbiased and scientific fashion. Physiological, diagnostic, and therapeutic implications will all be addressed in this study.

Paracelsus, Paracelsianism, and the secularization of the worldview

This paper examines Paracelsus and Paracelsianism in the light of the ideas of Max Weber concerning the social consequences of the Reformation, with special reference to his theories of Entzauberung and secularization. He linked these tendencies both to the rise of capitalism and the growth of experimental science. The detailed case study of Paracelsus' account of diseases linked with saints, in common with his interpretation of many other conditions, demonstrates that he self-consciously extended the boundaries of medicine and eroded the role of magic and witchcraft associated with the church. On the other hand, Paracelsus adopted the Neoplatonic worldview, was immersed in popular magic, and evolved a system of medicine that self-consciously revolved around magic. These factors seem to place a distinct limit on his role in the demystification of knowledge. However, the magic of Paracelsus entailed a decisive break with the entrenched elitist and esoteric tradition of the occultists and hermeticists. It is argued that this reconstructed magic re-establishes the credentials of Paracelsus as a significant contributor to the disenchantment and secularization of the worldview.

The earliest case of cauda equina syndrome caused by manipulation of the lumbar spine under a general anaesthetic

Jonathan Hutchinson described a 42-year-old man with a previous history of alternating sciatica who had crushing of a pile under ether anaesthesia in 1889. When the patient awoke from the anaesthetic he had paralysis of his bladder and bowels. Jonathan Hutchinson could not establish a diagnosis. Evidence is presented to suggest that this was the first case of a prolapsed disc causing a cauda equina lesion as a result of anaesthesia and manipulation.

[From sciatica to intervertebral disk displacement. On the history of a disease concept]

Since antiquity low back pain spreading down to the buttock and the leg with or without neurological symptoms has repeatedly been described by medical authorities. To extract well defined nosological entities out of the medley of "sciatica" was a demanding process within a labyrinth of often misleading clues. Although the herniated intervertebral disk was recognised about the middle of the 19th century the causal nexus between intervertebral disk displacement and sciatica was only demonstrated in the thirties of the 20th century. The critical appraisal of pathomorphological lesions in patients suffering from sciatica was, as it still is, a challenging task even for experienced physicians. Key texts and their authors recall the main steps towards our modern concept of lumbar intervertebral disk displacement to the readers mind.

Basic and update knowledge of intervertebral disc herniation: review

Lumbar disc herniation is one of the most common causes of low back pain and/or sciatica. However, the pathogenesis of lumbar disc herniation, low back pain, and sciatica has not been fully understood. Inflammation in nerve root and dorsal root ganglia induced by nucleus pulposus may play an important role in the pathogenesis of spinal pain. I reviewed the basic and update papers regarding lumbar disc herniation. Herniated nucleus pulposus had been considered an enchondroma occurred from intervertebral disc, historically. At present, however, it is emphasized that nucleus pulposus has an inflammatogenic properties to affect the nerve root function, structure, vascular permeability, and pain.

William Jason Mixter (1880-1958). Ushering in the "dynasty of the disc"

William Jason Mixter was born in 1880 and graduated from the Harvard Medical School class of 1906. Like his father, Mixter was a prominent surgeon at the Massachusetts General Hospital, and in 1911 the two shared the job of overseeing all neurosurgery at that institution. By the early 1930s, W. J. Mixter was considered to be one of the nation's leading experts in spinal surgery, and he went on to become the first chief of the neurosurgery department at Massachusetts General Hospital. He served in the U. S. Army in both world wars and was actively involved in his local church community in Boston for many years. In 1934, at the age of 54, Mixter and Joseph S. Barr published an article on the intervertebral disc lesion in the New England Journal of Medicine. That article fundamentally changed the popular understanding of sciatica at that time, and for this work Mixter is generally credited by his contemporaries as being the man who best clarified the relation between the intervertebral disc and sciatica. Mixter and Barr's landmark report helped to establish surgery's prominent role in the management of sciatica at the time. Over the next few decades, discectomy surgery increased in popularity tremendously, and some refer to that period as the "dynasty of the disc."

[Surgery of lumbar disk hernia: historical perspective]

Although the clinical picture of discogenic sciatica is well known already in the ancient world, it is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. The work of the American Authors was however based on the knowledge acquired during the previous centuries starting with Domenico Cotugno, who first suggested the neurogenic nature of sciatica (1764) and later with the neurologists of the french school Valleix, Lasègue, Dejerine, Sicard who elucidated the semeiology and debated in detail the etiopathogenesis of the condition. The german pathologists Schmorl and Andrae (1927-29) are to be credited for their contribution to the pathology of intervertebral disc, recognizing the frequency and degenerative (not neoplastic) nature of nucleus pulposus herniation. Surgery of disc herniation starts with Oppenheim and Krause (1909). Mixter and Barr used laminectomy and a transdural route although a more limited approach to the spinal canal had already been proposed by the italian Bonomo (1902), unknown to many. Love, of the Mayo Clinic (1937-39) introduced the extradural/interlaminar approach while Caspar and Yasargil (1977) applied the concepts of microsurgery to the procedure. The latest advances are represented by percutaneous and endoscopic techniques.

[Diagnostic imaging in sciatica. A short historical overview and current status]

Cotugno described the clinical entity of sciatica in 1764. However, the association between sciatica and compression of lumbar nerve roots was not realized until the 1920s. Back surgery for herniated nucleus pulposus then became fashionable, and plain radiography and myelography enabled preoperative mapping. Recently other imaging techniques have emerged, such as computed tomography and magnetic resonance imaging. This has increased the knowledge of the etiology of lumbar root compressions, and invasive therapies for sciatica have become more diversified. It is easy to lose perspective among the available imaging procedures and therapeutic techniques. The aim of this paper is to present the current status from a historical point of view, with special emphasis on the most common imaging methods for the investigation of lumbosacral radiculopathies.

Intraspinal therapy using methylprednisolone acetate. Twenty-three years of clinical controversy

The intraspinal use of methylprednisolone acetate (Depo-Medrol, Upjohn Company, Kalamazoo MI) began in 1960, followed 10 years later by reports of complications. In 1960, methylprednisolone acetate was first injected by the epidural route to treat low-back syndromes. Then in 1961, the intrathecal route was more widely used to treat arachnoiditis and multiple sclerosis. Epidural therapy again came into general use in 1980 for the treatment of the failed-back syndrome because intrathecal therapy was virtually abandoned after 10 years of spirited scientific controversy. Epidural steroid therapy is now employed extensively, and there are many sanguine reports of its efficacy in treating chronic pain secondary to the failed-back syndrome, but there have also been reports of complications. This review was prompted by recent manufacturer warnings, as well as by an ongoing heated controversy in Australia regarding its use epidurally. During the last 30 years, one can define 5 instructive historical parallels between intrathecal and epidural steroid therapy, and this historicity points up several principles that should govern any further epidural therapy with methylprednisolone acetate. This critical chronologic review surveys neurosurgical use from 1960 to 1970, neurologic use from 1970 to 1980, and anesthesiology use from 1980 to present.

An historical perspective on low back pain and disability

This review of low back pain and sciatica over the past 3500 years tries to put our present epidemic of low back disability into historical perspective. Backache has affected human beings throughout recorded history (Table 1). What has changed is how it has been understood and managed. Two key ideas in the nineteenth century laid the foundation for our modern approach to backache: that it came from the spine and that it was due to injury. Backache had always previously been considered a rheumatic condition. Only from that time were backache and sciatica considered and treated together. Their management was increasingly dominated by the new orthopedic principle of therapeutic rest. What is new is chronic disability due to simple backache. Apart from rare cases, this only began to appear in the late nineteenth century. It escalated after World War II. It appears to be closely related to changed understanding and management of backache: specifically to the idea that backache is due to serious spinal injury or degeneration and to medical prescription of rest. This is reinforced by the improved social support which makes rest possible. Sadly, we must conclude that much low back disability is iatrogenic.

Charles Lasègue and his 'Considerations on Sciatica'

The eponym Lasègue sign has been applied to the increase in sciatic pain caused by flexing the extended lower extremity on the abdomen. The sign was never put into writing by Lasègue but by his pupils. He did not describe the test in the usual reference, "Considerations on Sciatica," in 1864. That article has to do with his analysis of then-current theories of sciatica and his own clinical observations. Sciatica was divided into a benign and a serious form, and two examples of each were described. Emphasis was laid on the constant, fixed sciatic pain, as contrasted with the irregular, largely nocturnal, episodes of lancinating pain. Atrophy of leg muscles was not to be explained on the basis of disuse but by a disorder of the nerve, which also was responsible for the typical neuralgia, unlike that of any other part of the body except possibly neuralgia of the brachial plexus. Treatments currently available (cupping, vesicants, and injections of atropine solution) were unavailing. The steps are unknown by which Lasègue came to modify his 1864 views that any sort of flexion or extension of the lower extremity did not exacerbate the pain; in the 1881 thesis of his pupil, Forst, that straight-leg raising sign is described and illustrated and ascribed to his teacher, Professor Lasègue.

Lumbar nerve root: the enigmatic eponyms

Man's quest for recognition has not escaped the physician, whose contributions to medicine perpetuate his name in print. It is a final grasp for professional immortality, which for men like Imhotep and Hippocrates, has prevailed for millennia. This fervor was particularly evident in the latter 19th century, which created a flurry of eponyms, often two or more physicians publishing the same clinical observation. This article reviews the eponym epidemic as it relates to lumbar radiculopathy.

Sciatica and the lumbar disk syndrome: a historic perspective

The dynamics of the human spine mark the lumbar disk syndrome and accompanying sciatic complaints as long-standing afflictions of our species. Although Greco-Roman erudition suitably described the ailment, uneven diagnostic and therapeutic acumen confused inquiry for many centuries. Only with the 19th Century advent of improved clinical facilities, pathologic correlation, and active surgical exploration did real insight commence. Not, however, until the 1934 landmark publication of Mixter and Barr was the herniated lumbar disk indicated as a major cause of sciatica. Despite such advances, numerous unresolved issues still surround this disease.