Radiculopathies

Question 1

What is a prolapsed lumbar disc?

Answer 1

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

Question 2

What are the features of a prolapsed disc?

Answer 2

Leg pain usually worse than back pain, often worse 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, positive femoral stretch test.

Question 4

What are the features of L4 nerve root compression?

Answer 4

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

Question 5

What are the features of L5 nerve root compression?

Answer 5

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

Question 6

What are the features of S1 nerve root compression?

Answer 6

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

Question 7

What is the management for a prolapsed disc?

Answer 7

Similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, exercises.

Question 8

What does NICE recommend for drug treatment in prolapsed disc?

Answer 8

Use the same drugs as for back pain without sciatica symptoms; first-line is NSAIDs +/- proton pump inhibitors rather than neuropathic analgesia.

Question 9

When should referral for MRI be considered in prolapsed disc?

Answer 9

If symptoms persist after 4-6 weeks.