disc prolapse

Question 1

35 y.o. manual labourer was lifting a heavy box 2 weeks ago when he noticed sudden sharp low back pain

pain increases of coughing or sneezing, radiates down left leg to his toes

numbness of the dorsum of the left foot, can’t extend his toes

forward flexion of lumbar spine markedly restricted

you suspect prolapsed intervertebral disc

(a) given the hx and signs, which nerve root is being compressed?

Answer 1

left L5

Question 2

(b) what would you expect to see when examining this pt’s knee and ankle reflexes?

Answer 2

normal

Question 3

(c) with the pt in a supine position, what test would you perform to help establish the dx and what would this show?

Answer 3

straight leg raising would demonstrate pain in sciatic nerve distribution

Question 4

(d) give one example of rx that would be beneficial in each of the following examples:

(i) paramedical therapy

(ii) drug therapy

Answer 4

(i) physiotherapy, heat and massage, keep active
(ii) NSAIDs

Question 5

(e) what is the most appropriate ix that you would carry out to confirm your dx?

Answer 5

MRI lumbar spine

Question 6

(f) in <50 words, define what surgical rx is appropriate and explain what proportion of pts are likely to require surgery

Answer 6

discectomy - removal of part of nucleus pulposus of the intervertebral disc that has herniated

~1 in 10 will require surgery

Question 7

(g) name 2 local complications of surgical rx

Answer 7

1. CSF leak
2. bleeding
3. infection