It seems that, if one recognizes the reflex character in a large number of cases of low-back pain with sciatic radiation, the entire aspect of the prognosis and treatment changes. It becomes evident that the sciatic radiation stands or falls with the success or failure of immobilizing treatment for the local back lesion,-whether this immobilizing treatment consists in merely external immobilization by plaster cast or external appliance; or in internal fixation, if external immobilization is inadequate; or even in the elimination of a painful joint by resection, as in the transversosacral syndrome; or in the relief of the tension which cannot be accomplished by immobilization, as in the operation of Ober.
Since the publication of the former paper on the novocain diagnostic test, Dr. Luck and the author have information on the end results of immobilization treatment of low-back pain with sciatic radiation. In 100 consecutive cases apparently suitable for the test, the test was positive in sixty-nine and negative in thirty-one. Of the sixty-nine cases in which the test was positive, the end results were good in fifty-eight, or 84 per cent., and poor in eleven, or 16 per cent. Of the thirty-one cases in which the test was negative, the end results were good in six, or 20 per cent., and poor in twenty-five, or 80 per cent. The type of immobilization ranged from bed rest with traction, casts, and braces to fasciotomy, transversectomy, and fusion.
We feel that, in a considerable proportion of the cases of low-back pain with radiation, the recognition of the reflex character is essential for rational diagnosis and treatment of the condition.
(C) 1940 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.