Radiculopathy associated with disc herniation.

HAS THERE BEEN PROGRESS IN THE PHYSIOPATHOLOGY OF DISC HERNIATION ASSOCIATED RADICULOPATHY? Since 1934, when a link was demonstrated between disc herniation and sciatica, it has been accepted that compression of the nerve root by disc herniation explained the sciatica. Surgical treatment therefore became standard when medical treatment failed. It now seems that ‘‘chemical’’ factors have a central role in sciatica. The clinical arguments supporting the ‘‘chemical’’ theory are numerous. Laminectomy is sometimes ineffective, the long term success rate being 40– 80%, and reintervention rates are reported to be 5–25%. A considerable amount of asymptomatic disc herniation and severe sciatica without visible root compression has been reported; there is poor correlation between the severity of symptoms and the extent of the disc herniation; and the outcome, frequently favourable, is similar after conservative and surgical treatment. 11