Department of Neurosurgery, Drexel College of Medicine, 2630 Holme Avenue, Suite 103, Philadelphia, PA 19152, USA.
Acta Neurochir (Wien). 2010 Sep;152(9):1555-8. doi: 10.1007/s00701-009-0315-4. Epub 2009 Apr 30.
Francis Murphey's theory was analyzed to determine whether or not his opinion is evidence-based medicine and whether or not it can be applied clinically.
The English literature was reviewed using Medline in reference to Dr. Murphey's theory of discogenic chronic LBP, which was first postulated in 1967. Deductive and inductive logic was utilized for the evaluation of his theory. We reviewed and analyzed his unprecedented study of the annulus fibrosus (AF) and posterior longitudinal ligament (PLL) under local anesthesia that was presented to the Congress of Neurological Surgeons in 1967 and 1972.
He reported that: "It is found that the posterior longitudinal ligament and the remaining annulus fibrosus over the herniated discs are also exquisitely tender; even the slightest pressure on them produces pain." We noticed that in Dr. Murphey's presentation, he did not disclose any hard data, yet he concluded: "when an incomplete tear in the annulus occurs and if the tear is in the midline posterior, a fragment of nucleus will protrude in this tear, stretching the annulus and posterior longitudinal ligament, causing midline back pain. If the tear in the annulus is lateral, the pain is over the sacroiliac joint in the buttock and hip, and 20% of the patients in the lower abdomen, groin or testicle on that side."
Because of a flaw in his understanding, in our opinion the unproven mechanical theory of discogenic LBP is weak inductive logic and does not justify discography and intra-discal procedures.
分析弗朗西斯·默菲（Francis Murphey）的理论，以确定其观点是否为循证医学，以及是否可以将其应用于临床。
使用 Medline 检索英文文献，参考默菲博士于 1967 年首次提出的椎间盘源性慢性 LBP 理论。运用演绎和归纳逻辑对其理论进行评估。我们回顾和分析了他对纤维环（AF）和后纵韧带（PLL）进行局部麻醉的前所未有的研究，这些研究于 1967 年和 1972 年提交给神经外科学会大会。
他报告说：“发现后纵韧带和椎间盘突出部位的剩余纤维环也非常敏感；即使对它们施加最轻微的压力也会引起疼痛。”我们注意到，在默菲博士的演讲中，他没有透露任何硬数据，但他得出结论：“当纤维环发生不完全撕裂时，如果撕裂位于中线后部，核的一部分将在该撕裂处突出，拉伸纤维环和后纵韧带，导致中线背痛。如果纤维环的撕裂位于外侧，则疼痛位于臀部和髋部的骶髂关节上方，20%的患者在该侧的下腹部、腹股沟或睾丸处有疼痛。”
由于他的理解存在缺陷，我们认为椎间盘源性慢性 LBP 的未经证实的机械理论是弱归纳逻辑，并且不能证明椎间盘造影术和椎间盘内程序的合理性。
