Sciatica/ Lumbar Radiculopathy

Question 1

definition of disc prolapse

Answer 1

herniation of the nucleus pulpous due to a tear in the annulus fibrosus

Question 2

pathophysiology of disc prolapse

Answer 2

the disc herniation can compress an exiting nerve root resulting in pain and altered sensation in a dermatomal distribution as well as reduced power in a myotomal distribution

Question 3

common sites of disc prolapse

Answer 3

L4/L5 or L5/S1

Question 4

sciatica

Answer 4

pain caused by compression or irritation of one or more nerves exiting the lower spine that make up the sciatic nerve

Question 5

pain in sciatica is called

Answer 5

radicular pain and is felt as a neuralgic burning or severe tingling down the back of the thigh to below the knee

Question 6

test for sciatica

Answer 6

patients normally have a positive sciatic stretch test and may have a cross over sign where sciatic stretch testing on the opposite side produces pain on the affected side

Question 7

which nerve root is usually compressed in a disc prolapse

Answer 7

• the lower one so in an L4/L5 prolapse L5 is compressed

and in an L5/S1 the S1 nerve is compressed

Question 8

symptoms of L4/L5 prolapse

Answer 8

pain down dorsum of foot, reduced power of extensor halllucis longus and tibias anterior

Question 9

symptoms of L5/S1 prolapse

Answer 9

pain to sole of foot, reduced power of plantar-flexion and reduced ankle jerk reflex

Question 10

exception to the nerve roots affected rule

Answer 10

a large lateral prolapse may impinge on the nerve root exiting above e.g in L4/L5 prolapse L4 may be compressed

Question 11

treatment of sciatica

Answer 11

1st line: NSAIDS and physiotherapy

80-90% of disc prolapses resolve spontaneously within 3 months but if not resolved within 3 months then DISECTOMY if there are signs of specific nerve root involvement and positive MRI evidence