A 48-year-old male football coach presents with a four-month history of right sided buttock, hip and anterior thigh pain. It had not improved despite rest and physiotherapy treatment. He was found to have a positive femoral nerve stretch test, 4+/5 weakness of right hip flexion and knee extension and an absent patellar jerk.
At the L3/4 level there is moderately reduced disc height and signal with reactive change in the vertebral endplates. There is a large, right-sided, foraminal disc protrusion which is filling the right neural foramen and compressing the exiting L3 nerve root. It is slightly deforming the ventral surface of the thecal sac and contacting the right L4 nerve root within the canal. There is no canal compromise or cauda equina compression. The left neural foramen is capacious.
A nerve root sleeve injection transiently improved this coach’s pain. Unfortunately, the symptoms returned after only a few weeks and the neurology did not improve. The patient had a good outcome following a discectomy. Four months after this procedure he had returned to normal activity, had no residual pain and had normal lower limb neurology.
In the majority of cases the pain related to lumbar radiculopathy settles spontaneously over a period of approximately three months. During this time physiotherapy treatments, analgesia and relative rest are often helpful. When the pain is more significant a foraminal steroid injection can be effective. When the pain is very severe however, or when it is associated with pronounced weakness or other focal neurological signs, a lumbar discectomy can be very effective.
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