Spine: Prolapsed Disc

Question 1

What are features of prolapsed lumbar disc?

Answer 1

Clear dermatomal leg pain a/w neuro deficits
Leg pain worse than back
Pain worse when sitting

Question 2

L3 nerve root compression features?

Answer 2

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

Question 3

L4 nerve root compression features?

Answer 3

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

Question 4

L5 nerve root compression features?

Answer 4

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Question 5

S1 nerve root compression features?

Answer 5

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 6

Ix of suspected LBP due to nerve root compression?

Answer 6

MRI

Question 7

Mx of LBP due to nerve root compression?

Answer 7

Similar to other MSK LBP: analgesia, physio, exercise
If Sx persist (e.g. after 4-6 weeks): refer for MRI (need intervention - injection or operation)

Question 8

What could be used for analgesia in LBP Mx?

Answer 8

Gabapentin, pregabalin or amitriptyline (neuropathic pain)
General analgesic (e.g. NSAID like naproxen)

NOT opiates as not helpful in neuropathic pain (+ dependence)

Question 9

What would suggest need for urgent referral in disc prolapse in history or MRI?

Answer 9

Bladder/bowel Sx
Weakness
Cauda equina compression

Question 10

All pt with nerve root compression should be given what?

Answer 10

Given red-flag advice for cauda equina syndrome + advised to attend ED if they develop any of:

Peri-anal or saddle sensory change
Difficulty passing urine
Symptoms affecting both legs