gms | German Medical Science

Objective: A historical method of exposure of the ischiadic nerve from the era prior to lumbar disc surgery is described. The outcome of treatment for sciatica was so astonishing that the reader today is compelled to doubt the literature reports of the success rates of such pain surgery.

Methods: We have analysed historical works by Professor Bernhard Heile, who, between 1914 and 1922, was one of the first to suggest decompression of the sciatic nerve in the sciatic foramen. We have summarised the results from his articles.

Results: Of the 300 patients presented to the surgeon, 20 underwent surgery. Using a strict diagnosis (therapeutic resistance, positive provocation tests), he achieved a pain-free status in 75% without surgical complications. 15% described a clear improvement in pain, 10% recurrent pain after an initial improvement.

Conclusions: From this work we can identify the attempt to break away from a concept of inflammation as a cause of sciatica in order to be able to use minimally invasive surgical techniques based on theories of mechanical genesis. With contemporary diagnosis and microsurgery, suitable patients can perhaps be recruited to undergo an historical surgical procedure. But perhaps the procedure will also suffer the fate to which it was once destined almost 100 years ago.