Lumbar Herniated Disc

Question 1

What is a lumbar herniated disc?

Answer 1

Nucleus pulposus extrusion
- Leads to radiculopathy

Posterolateral portion weakens over time
- Herniates in lumbar canal as spinal nerve is exiting

Question 2

What is the most common location lumbar herniated disc?

Answer 2

L4-5- L5 nerve

L5-S1- S1 nerve

Question 3

What are the s/s of lumbar herniated disc?

Answer 3

Abrupt vs insidious

Low back pain with unilateral radicular leg pain

Exacerbated

• sitting
• walking
• standing
• coughing
• sneezing

Radiates from buttock down posterior leg to foot

Upper or mid-lumbar radiculopathy

• Pain to anterior aspect of thigh
• Doesn’t go past knee

Question 4

What is observed in physical exam of lumbar herniated disc?

Answer 4

Inspection- List/Trunk shift
TTP lumbar spine
Decreased ROM
Sciatica
- Pain down the posterior leg
Positive seated SLR and SLR
- Asymptomatic leg is raised, increases pain on symptomatic side
- Highly specific to herniated disk
Upper nerve roots
- Reverse SLR
Motor and sensory

Question 5

What is sciatica?

Answer 5

Inflammation of sciatic nerve

Question 6

What are the expected findings of lumbar herniated disc?

Answer 6

L3-L4
L4-L5
L5-S1

Question 7

What is the imaging used in lumbar herniated disc?

Answer 7

Plain films
- Degenerative changes

MRI
- Neurologic changes and intolerable pain

Question 8

What are the conservative options of lumbar herniated disc?

Answer 8

• NSAIDs, rest, PT
• Epidural steroid injections
• Manipulative therapy
• Traction
• Acupuncture

Question 9

What are the surgical options of lumbar herniated disc?

Answer 9

Decompression

• Microdiscectomy
• Laminectomy