Abstract: Some years ago my colleagues and I undertook a study of the etiologic aspects of pain in the lower part of the back and of sciatica. We had intended to study the factors concerned among all patients at the Mayo Clinic presenting this as one of their major complaints during a period of a year. The material became so great, however, and the figures so involved, that we were forced to limit our study to 2,000 patients. This was approximately 40 per cent of the patients seen in the course of one year. We have already published the tabulation of the results of our studies (1, 2). That these figures do not represent a cross section of the population is obvious, for the patients concerned were those who came to the Mayo Clinic for counsel about various complaints. Many had received treatment for pain in the lower part of the back or for sciatic pain, and correct diagnoses had been made before they entered the Clinic. Osteoarthritis In the largest group of cases the causative condition was diagnosed as osteoarthritis (Table I). This admittedly is a poor diagnosis, for in most of these cases there is no real arthritis. The hypertrophic or degenerative changes which are noted often arise as a result of wear and tear, hard usage, and injury. Patients with this condition frequently are free of symptoms as long as they do not indulge in hard work or other forms of activity which may cause local irritation around the vertebrae and thus incite pain. Many in this group had symptoms suggesting fibrositis; some had other conditions, such as disease of the genitourinary tract, which might have contributed to their symptoms. Suspected Protruded Intervertebral Disk Many patients are sent to the Mayo Clinic with a diagnosis of protruded intervertebral disk. It is to be expected, therefore, that in a large proportion of our cases the pain would be attributed to that condition. This number, 445, represented about 22 per cent of the entire series. Of these 445 patients, 161, or 36 per cent of those suspected of having a protruded intervertebral disk, were operated upon. In 121 cases a protruded disk was removed without performance of fusion, whereas in 26 cases a protruded disk was removed and fusion was performed. Among 14 cases in which a protruded disk was not found at operation, fusion was performed in 8. The remainder of the patients were treated conservatively. A few were advised to undergo operation, but refused. A total of 324 of the patients suspected of having a protruded intervertebral disk, or approximately 73 per cent, also had sciatic pain at the time of examination. Indeterminate Causes In a group of 384 cases, or about 19 per cent, the back pain was of a mixed type, the exact nature of which it was difficult to determine. In some instances a “fibrositic” type of pain predominated, and doubtless fibrositis or myositis was present in many cases.
Publication Year: 1958
Publication Date: 1958-05-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 13
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