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Herniated intervertebral disk, or herniation of the nucleus pulposus, has become a well established syndrome. The lesion is clearly a causal factor for low back pain associated with radiating pain in the sciatic distribution. While the incidence of herniated disks in "sciatic cases" appears to be growing ever larger, there is nevertheless a group of cases in which the back pain and sciatic radiation is related to soft tissue or myofascial injury. Out of the fog of ignorance which has hung for so long over the subject of low back pain these two lights of knowledge have appeared. Each of these two causal factors is productive of definite syndromes and lends itself by the use of proper methods to a high percentage of accurate diagnoses. They indicate prescribed methods of treatment which are rewarded by almost uniformly excellent results. Since in any case of low back pain with sciatic radiation one of these two causal factors is likely to prevail, it is paramount that their respective syndromes and their differentiation be clearly understood.Herniated disk provokes a syndrome of spinal nerve root compression, and the radiating pain is referred pain associated with the signs and symptoms that attend direct root involvement. We do not believe that herni¬ ated disk is the only cause of referred sciatic pain, but it is the most common cause. For example we have seen cases that present a perfect syndrome for a single nerve root compression and in which a diagnosis of herniated disk was mandatory. A herniated disk (con¬ cealed or otherwise) was not found to be present, but a decompression of the intervertebral canals of appropri¬ ate roots was followed by excellent results. This has been consistent. The causal factor in these cases is not yet so well understood but the pertinent point is that the diagnostician might think more broadly in terms of nerve root compression rather than specifically of herniated disk.The myofascial syndrome is associated with or pro¬ vokes a strictly reflex sciatic radiation and hence can be differentiated from referred sciatic radiation. This paper is a presentation of our experience with these cases, and for convenience it is divided into two parts. Part I is devoted to the cases in which a diag¬ nosis of root compression with radiating pain was made. Herniated disk was the predominant cause and we have elected this as the title of the paper. Special emphasis is placed on the interpretation of the iodized oil film. Having become thoroughly acquainted with the impor¬ tant features of the iodized oil column, we now use the method only in the occasional case in which such a precise confirmation is desired. In addition to the 63 cases reported in this paper we have since clone 26 additional laminectomies for herniated intervertebral disk. Of these, 17 were done without confirmation by iodized poppy seed oil. In only 1 case was the lesion not found. Iodized oil was used in 9 cases. The iodized oil films were positive in 6 of these and disks were found. They were negative in 2 cases in which herni...

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