Prolapsed intervertebral disc

Abstract

Chapter 11 described one of the mechanisms of classical prolapse of the lumbar intervertebral disc. Although nearly all authors agree that in Britain two people in every hundred visit their medical practitioner every year complaining of low back pain, there is little agreement as to how much of this back pain can be attributed to the intervertebral disc. On the one hand Cyriax (1969) ascribes over 90 per cent of all organic symptoms of the lower back to disc disease whereas Dixon (1976) believes prolapsed intervertebral disc to be the most overdiagnosed cause of back pain, and Wyke (1976) emphasizes that less than 5 per cent of patients with backache have prolapsed discs. Many authors simply write that disc disease is common and refer to the 15 per cent or so incidence of pathological discs seen in routine post-mortems. Williams (1974) states that the disc between L₅ and S₁ has ruptured in the majority of all persons by the age of 20 years and, as a result, most people at this age are subject to pain even though they have not yet experienced any significant discomfort. They do not have long to wait because setting aside Adams’s (1971) quoted age range of 18–60 years for disc prolapse, it is more often believed to be a condition primarily of young adults — more commonly males and those subject to heavy work.