Disc Prolapses

Abstract

Despite the fact that Mixter and Barr published their description of rupture of the intervertebral disc with involvement of the spinal canal in 1934, confusion still exists about the diagnosis of this lesion and there is often uncertainty about which cases should be treated surgically. The fact that disc prolapses which require surgery are not common is still not widely accepted. In the past ten years extraordinary advances have been made in the development of instruments, lighting, photographic and video recording systems relative to endoscopic surgical equipment and operating microscopes. While large joint surgery has already been revolutionised as a result of the wider use of this technology in orthopaedic surgery, its application in spinal surgery has not yet been clearly established. Until that goal has been reached, the principles that govern surgical approaches to the spinal canal deserve to be restated in the interests of sound surgical education and for the benefit of young surgeons in parts of the world where advanced medical technology may not be available to benefit them and their patients. Even from the vast literature on this subject the synthesis of practical guidelines to diagnosis and surgical management can be made only with difficulty.