The typical syndrome of an intervertebral disk rupture or protrusion in the low back is well defined and generally known; however, in a large percentage of patients suffering from this condition the symptoms and findings on physical examination and on roentgenograms are not typical. Even in a series that is limited to patients in whom the diagnosis was proved at operation and in whom the symptoms were relieved by the operation, the picture may be extremely variable. At one extreme are those patients with a chronic bilateral low back pain of gradual onset, in whom the only positive preoperative physical finding is local tenderness to deep pressure over the lumbar disk. At the other extreme are those patients with a history of severe low back pain and sciatica following an injury to the back, who have abnormal posture, marked limitation of movement in the low back and on straight leg
Odell RT, Key JA. LUMBAR DISK SYNDROME CAUSED BY MALIGNANT TUMORS OF BONE. JAMA. 1955;157(3):213–216. doi:10.1001/jama.1955.02950200011003
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