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This concise monograph contains 70 pages of text and an appendix of extremely useful details for physical examination and recording methods. It reports an excellent objective long-term (20 year) study of a large sample of patients with herniated lumbar disks during World War II. Statistical correlations are presented in detail for patients both operated on and not operated on. Although the authors are careful about drawing conclusions and the monograph "raises more questions than it answers," the large volume of data that have been analyzed contributes significantly to our understanding of the natural history of lumbar disk diseases.
Correlation of clinical and diagnostic findings indicated that reflex and sensory signs are not good criteria for localization of the disk lesion. Although trauma appeared to be associated with the onset of symptoms in most instances, other varieties of musculoskeletal involvement frequently appear to represent predisposing factors in disk herniation. Although statistical
Siffert RS. Lumbar Disc Disease: A Twenty-Year Clinical Follow-Up Study.. Arch Intern Med. 1973;131(4):617-618. doi:10.1001/archinte.1973.00320100145044