Lumbar Prolapsed Disc

Question 1

Findings on examination for LPD

Answer 1

• SLR +ve - 30-70 degrees usually
• Reduce ROM lumbar spine due to paraspinal spasm
• Myotome weakness -if neurological component
• Dermatome parasthesia - if neurological component

Question 2

Mytomes and actions which will be affected

Answer 2

• L3 - hip adduction (or hip flexion)
• L4 - knee extension (knee reflex affected)
• L5 - ankle dorsiflex
• S1 - plantarflex foot (ankle reflex affected)

But these vary between passmed and teaach me anatomy so

Question 3

Cause of prolapse disc

Answer 3

• Same as degenerative disc disease card
• Disc dehydration
• = tears in annulus fibrosus
• = herniation of nucleus pulposus
• = compression of spinal nerve (traversing in lumbar, exiting in cervical but both will be second disc mentioned eg C5-C6 disc compresses C7 and L5-S1 disc compresses S1)
• Then fibrosis and ostephyte formation

Question 4

Progression of LPD

Answer 4

• Initially localised back pain
• Then radicular pain and parasthesia
• Stiffness, worsening muscle tenderness
• Reduced ROM

Question 5

When to investigate prolapsed disc?

Answer 5

Same as degen disc disease:
* Any red flags
* Radiculopathy >6 weeks
* SCC evidence
* Imaging will significantly alter management

Most patients with mild do not need imaging

Question 6

Management of prolapsed disc

Answer 6

As long as no red flags present:
* Simple analgesics and then neuropathic analgesics if needed (eg gabapentin, amytriptyline)
* Encourage mobility
* Physio
* If pain >3 months refer to pain clinic

If all this fails:
* Surgery decompression - laminectomy + microdiscectomy
* Spinal fusion if spinal instability

Question 7

Imaging for spine

Answer 7

• MRI gold standard for soft tissue things
• CT used to assess bone +/- osteoporosis
• X-ray only if recent significant trauma, known OP or older than 70