Our knowledge of herniation of lumbar intervertebral disc is relatively new. Until 1930 we did not know that a lumbar disc herniation can cause back pain and sciatica. The first authentic monogram recognizing the importance of herniation of lumbar intervertebral disc in causing symptoms of back pain and sciatica was published by Mixter and Barr in 1934.1 However, there are a few early records describing massive disc herniation following trauma. Middleton and Teacher2 in 1911 described a case of paraplegia following an effort to lift a heavy weight from the floor. The patient had died and postmortem examination had shown a piece of fibrocartilage lying in the extradural space thought to have come from T11/T12 intervertebral disc. Reports of chondromas causing compression of nerve roots have occasionally appeared in the literature. Elsberg in 1928 listed eleven such cases in his series of 46 extradural tumors. He opined that seven had come from intervertebral disc. In the same year (1928) Stookey described cartilaginous compressions seen by him during surgical procedures as chondromas. He carefully described clinical presentations of the patient to correlate with a particular nerve root compression by a chondroma. During the same period Schmorl was studying pathological change in the intervertebral disc. He along with Junghans carried out pioneering work and described the modern concepts of intervertebral disc. Their classical work, “The human spine in health and disease” was available in English language in 1971.3 Junghans concept of motion segment in the spine was an eye opener.4,5
In 1934 Peet and Echols were the first to suggest that what was hitherto been referred to as chondromas or ecchordosis was really a herniation of intervertebral disc. The paper in 1935 by Mixter and Iyer describing results of surgery in three patients gave important clinical and precise scientific information. In 1957 Payne and Spillane6 carried out autopsy studies and Ramani7 in 1976 carried out radiological studies to conclude that neural compression was more likely to occur if the disc protrusion occurred in a congenitally narrow canal. Since then rapid strides were made in explaining the factors leading to herniation of a given lumbar intervertebral disc. Addition of knowledge of biomechanics of functioning of the spine has helped us to understand the weight bearing principles of spine and how a given intervertebral disc can degenerate if these principles were violated. The addition of better understanding of anatomy of lumbar spine by CD Schneck8 (1983) and its correlation with degenerative changes in the lumbar spine describing evolution of lateral recess stenosis.
References
- McNab I. Mixter and Barr. William and Wilkins; Backache; 1977.pp. 51–63.
- O'Brien JP, Evans G. Middleton and Teacher. A review of laminectomies a correlation of disability with abnormal spinal movment. J Bone Jt Surg. 1978;60-B:439–48.
- Junghans J, Schmorl G. In: Grune and Stratton (Eds). The human spine in health and disease; 1971.pp.35–7.
- McNab I. Williams and Wilkins; Backache; 1977.pp.40–3.
- Ramani PS. Backache and Sciatica; 1996.pp.12–3.
- Payne EE, Spillane JD. Anatomico-pathological studies of 70 specimens with particular reference to spondylosis. Brain. 1957;80:571–96.
- Ramani PS. Variation in size of bony lumbar canal in patients with prolapsed lumbar intevertebal disc. Clin Radiol. 1976;27:302–11.
- Schneck CD. The anatomy of lumbar spondylosis. Clin Ortho and Related Research. 1985;193:20–36.