Lumbar Disc Prolapse

Question 1

ESSENCE

Answer 1

Central portion of intervertebral disc herniates beyond the firm outer ring

Question 2

COMPLICATIONS

Answer 2

Can lead to spinal inflammation +/- nerve root compression

Question 3

AETIOLOGY

Risk factors

Answer 3

• Manual labour
• Heavy lifting
• Competative sport

Question 4

CLINICAL FEATURES

Presentation

Answer 4

• Low back pain
• Radicular leg pain
  
  • Radiates from buttocks into leg, worsens with sitting and coughing, improves with standing
• Examination findings depend on location, LMN signs

Question 5

INVESTIGATIONS

First choice

Answer 5

• MRI first choice

Question 6

MANAGEMENT

General principles

Answer 6

• Conservative options
  
  • Rest, physical therapy and anti-inflammatory medication 1st line
  • Nerve root corticosteroid injections if fail
• Surgical options
  
  • Microdiscectomy if failure of conservative