BellKicker
Forum Junior
Topics: 3
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A 43-yo woman has been treated conservatively for lumbar disc herniation. She has been experiencing gradual increase in pain, numbness and paresthesias on her posterior thighs, lateral crus and 1st toe. Elective surgery is decided upon.
2 weeks before her appointment, the woman calls to cancel. The pain is now gone. She can't lift her toes but is able to walk by raising her knee higher than usual. She feels this is bearable and doesn't wish to go though surgery for it.
Next step:
a. Call her in for immediate examination/surgery
b. Tell her she will still benefit from the scheduled surgery.
c. Tell her to keep the appointment and you'll examine her before making up your mind..
d. Ask her about symptoms in contralateral leg.
e. Tell her of the high risk of recurrence of symptoms.
Other thoughts:
Which root was/is affected?
Which reflex can be absent?
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| bakpity
Forum Senior
Topics: 28
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Seems to be that L5 root is involved here, posterior tibial reflex used to be diminished.
I would go for immediate surgery since the reslution of symptoms indicate dying of the root.
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| BellKicker
Forum Junior
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Correct. This is herniation of the root and should be operated as soon as possible.
It's L5, like you said. The knee flexor reflex is absent. What exactly is the posterior tibial reflex (maybe the same thing?)
Bonus q:
Which discus is involved?
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| meg
Forum Guru
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L4
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| BellKicker
Forum Junior
Topics: 3
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Yes. You're right.
However, in a few rare cases, it could be caused by an extreme lateral herniation from the L5 disc. Also, a herniated disc can balloon upward or dive downward and confuse things.
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| meg
Forum Guru
Topics: 62
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thanks 
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