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

Abstract

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

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

“…In 1929, Baltimore neurosurgeon Walter Dandy ( Fig. 1 ) published his surgical experience [ 8 ] removing loose cartilaginous fragments transdurally, which he postoperatively concluded to be consistent with disc material and traumatic in nature [ 9 , 10 ]. Dandy described the disc material as bulging out like a tumor into the spinal canal, compressing the nerve roots of the cauda equina and causing radicular motor and sensory paralysis.…”

“…(B) Graphical sketch showing ruptured intervertebral disc herniating into spinal canal (C and D) transdural removal of the disc fragment. Panels B–D from Dandy’s original 1929 publication [ 10 ].…”