Exploration of the cauda equina in the region of the fifth lumbar vertebra for intractable low back and sciatic pain is now frequently performed by neurologic surgeons.1 For properly selected patients operation usually yields prompt and persistent relief from severe pain.2
However, further refinement in technic is suggested by the appreciable percentage of patients who suffer persistent or recurrent minor discomfort in the back. As emphasized previously,2 exploration should be adequate and usually should include the anterior aspect of the spinal canal both above and below the fifth lumbar vertebra, not only in the midline but also far laterally near the intervertebral foramen on each side. At the same time the less laminar bone removed, the more prompt will be convalescence and the less likely subsequent minor backache. Furthermore, while operation should be extensive enough to yield relief from pain, it should at the same time minimize
ECKER A. DECOMPRESSION OF PROTRUDED INTERVERTEBRAL DISKS: WITH A NOTE ON SPINAL EXPLORATION. JAMA. 1943;121(6):401–403. doi:10.1001/jama.1943.02840060019003
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