Herniated Disc: Multi-Specialty Case Review

Fig 1: Disc herniation
(larger view)

Chief Complaint: Right Leg Pain

History of present illness

42 year old female with an eight week history of mostly right leg pain. The pain radiates to the sole and outside of her foot and is accompanied by numbness and tingling. It is made worse with sitting, and she only has a 15 minute sitting tolerance. She has had a great deal of difficulty maintaining her full schedule as a mother and a secretary. She has had back pain in the past, but the episodes have always been brief and relieved with one or two chiropractic manipulations. This episode of pain started as back pain but within a week had moved to being mostly in her leg.

She is currently trying to manage her pain with Motrin and Tylenol, and is only able to work for three or four hours a day with frequent changes in position. At night she has trouble sleeping for more than one or two hours at a time.

Physical Exam

View Herniated
Disc Videos

42 year old healthy female who stands through most of the history. She has an absent ankle jerk on the right leg. There are no focal motor deficits, and the neurological exam is otherwise negative. She has a markedly positive straight leg test and crossed straight leg test (raising the affected and unaffected leg recreates her leg pain).

Imaging Studies

MRI scan (Figure 1) shows a large disc herniation at L5-S1. There is also disc degeneration present at the L5-S1 disc. The axial scan (not shown) shows that the disc impinges on the right S1 nerve root.