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Review Question - QID 154

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QID 154 (Type "154" in App Search)
45-year-old manual laborer presents to the office with acute onset back pain that radiates to his right leg after carrying a heavy object. He also has mild non-progressive weakness with ankle dorsiflexion on that side. A representative MRI cut is shown in Figure A. What should be his initial treatment?
  • A

Microdiskectomy

7%

227/3385

Posterior spinal fusion with instrumentation

0%

16/3385

Decompression only

2%

78/3385

Strict bedrest

1%

23/3385

Anti-inflammatory medication and physical therapy

89%

3014/3385

  • A

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Lumbar disc herniation is the most common cause of radicular pain in the adult working population. 95% of these herniations involve L4/5, L5/S1 lumbar disc spaces. Patients typically present with low back pain and sharp stabbing leg pain with sensory symptoms in a specific dermatomal distribution. Persistent intractable pain following non-surgical treatment during a minimum 6 week period is the most frequent indication for surgery.

The Weber article was a RCT over 10 yrs of 126 pt with sciatica due to herniated lumbar discs. The results of surgical treatment were significantly better than the results in the conservatively treated group after one year of observation, however this difference became much less pronounced after nine more years.

Saal et al retrospectively reviewed 11 patients treated nonoperatively with lumbar disc extrusions through CT/MRI to evaluate disc morphology initially and at follow up (mean 25 mos). Only 1 patient had progression of stenosis, and all patients had disc dessication at the level of disc herniation with contiguous levels being normally hydrated. All patients had a decrease in neural impingement.

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