The lateral extracavitary approach to the spine was used for resection of displaced bpne and disc located anterior to the dura in 62 patients with traumatic lesions of the thoracic and lumbar spine. Fifty-two patients had closed vertebral fractures and 10 had gunshot wounds. The spinal cord was involved in 44 patients, and the cauda equina in 18. A spinal subarachnoid block was demonstrated in 17 of 57 preoperative gas myelograms. Evoked potential recordings, although related to preception of joint rotation, tended to reflect the overall neurological condition and had some prognostic value. Significant improvement followed surgery in 46 patients with incomplete neurological lesions, and one was transiently worse. Before operation 18 patients were able to walk; nine with assistance and nine without. After operation 47 patients were able to walk; 12 with assistance and 35 without. Adequate bladder function was present in 17 patients before surgery, and in 44 after surgery. A laminectomy had been done previously in 16 patients, 11 of whom improved significantly after anterior resection. Spine fusions were required in 26 patients, five of whom had a prior laminectomy. The major factor in the pathogenesis of the incomplete neurological deficit appeared to be distortion of the cord and roots by displaced bone and disc. Consequently, the primary object of treatment was the restoration and maintenance of normal anatomical relationships between the spinal cord or cauda equina and the spinal canal.

SYNOPSISThe results of chemonucleolysis in 48 patients with lumbar disc disease revealed marked improvement in 58 %, slight improvement in 23 %, and no improvement in 19 %. Serious anaphylactic reactions occurred in two patients. These results and those of other neurosurgical and orthopaedic studies are summarized and compared with the 70 % improvement rate obtained with a placebo in a recent double blind controlled cooperative study. Only those few investigators participating in the double blind study are now permitted to use intradiscal chymopapain. It is concluded that the ultimate place of chemonucleolysis, if any, in the treatment of ruptured lumbar discs remains to be determined.

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