Radiculopathies

Question 1

What is a prolapsed lumbar disc associated with?

Answer 1

A prolapsed lumbar disc usually produces clear dermatomal leg pain associated with neurological deficits.

Question 2

How does leg pain from a prolapsed disc compare to back pain?

Answer 2

Leg pain is usually worse than back pain and often worsens when sitting.

Question 3

What are the features of L3 nerve root compression?

Answer 3

Sensory loss over anterior thigh, weak hip flexion, knee extension, and hip adduction, reduced knee reflex, and positive femoral stretch test.

Question 4

What are the features of L4 nerve root compression?

Answer 4

Sensory loss on the anterior aspect of the knee and medial malleolus, weak knee extension and hip adduction, reduced knee reflex, and positive femoral stretch test.

Question 5

What are the features of L5 nerve root compression?

Answer 5

Sensory loss on the dorsum of the foot, weakness in foot and big toe dorsiflexion, reflexes intact, and positive sciatic nerve stretch test.

Question 6

What are the features of S1 nerve root compression?

Answer 6

Sensory loss on the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and positive sciatic nerve stretch test.

Question 7

What is the management for a prolapsed lumbar disc?

Answer 7

Management is similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, and exercises.

Question 8

What does NICE recommend for medication in cases of prolapsed lumbar disc?

Answer 8

NICE recommends using the same drugs as for back pain without sciatica symptoms, i.e., first-line is NSAIDs +/- proton pump inhibitors rather than using neuropathic analgesia (e.g., duloxetine).

Question 9

What should be done if symptoms persist after 4-6 weeks?

Answer 9

If symptoms persist, referral for consideration of MRI is appropriate.

Question 10

Site of compression & features

Answer 10