The classical presentation of CES is not obvious. Even if surgery is performed late due to delayed presentation, significant improvement in neurologic and bladder function can still be expected. Copyright 2014, SLACK Incorporated. [ncbi.nlm.nih.gov]

A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms. [nejm.org]

• Lower Extremity Pain

  Review Ohnmeiss DD, Vanharanta H, Ekholm J:Degree of disc disruption and lower extremity pain. Spine. 1997 Jul 15;2214:1600-5. 8.Spencer DL: The anatomical basis of sciatica secondary to herniated lumbar disc: a review. [hss.edu]

  (SBQ12SP.42) A 56-year-old man presents with 6 weeks of worsening back and left sided lower extremity pain and weakness. He has severe pain that radiates from the back to the groin and anteromedial thigh. His axial MRI image is shown in Figure 1. [orthobullets.com]

• Limb Pain

  Review Topic QID: 3706 1 Equal limb pain and equal functional outcomes 2 Improved limb pain and improved functional outcomes 3 Worsened limb pain and worsened functional outcomes 4 Worsened limb pain but improved functional outcomes 5 Improved limb pain [orthobullets.com]

• Soft Tissue Mass

  mass within or lateral to the intervertebral foramen. [ncbi.nlm.nih.gov]

• Constipation

  Very large disc herniations may result in urinary difficulty and constipation. In cervical disc herniation, the spinal cord as well as the nerve roots may be compressed. [uclahealth.org]

  Constipation is a common side-effect from codeine. This may make back pain worse if you need to strain to go to the toilet. To prevent constipation, have lots to drink and eat foods with plenty of fibre. [patient.info]

  Side effects include sedation, nausea, and constipation. Epidural steroid medication (injected into the space just outside of the sac of spinal fluid), reduces swelling, inflammation, and pain. [innerbody.com]

• Fecal Incontinence

  If the anal sphincter is not working, fecal incontinence may occur. This means the patient loses the ability to control the passage of stool from the bowels. If the urethral sphincter is not working properly, urine leaks from the bladder. [livestrong.com]

  incontinence as well as sexual dysfunction. [physio-pedia.com]

• Retinal Hemorrhage

  In the right eye multiple, flat, retinal hemorrhages around the optic disk and the posterior pole were observed. The MRI scan for intracranial hemorrhage was unremarkable. [ncbi.nlm.nih.gov]

• Macula

  Ophthalmoscopy revealed a premacular hemorrhage involving the left macula. In the right eye multiple, flat, retinal hemorrhages around the optic disk and the posterior pole were observed. The MRI scan for intracranial hemorrhage was unremarkable. [ncbi.nlm.nih.gov]

• Back Pain

  The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity. [ncbi.nlm.nih.gov]

  “Red flags” for potentially serious underlying causes of low back pain. Adapted from ACR Appropriateness Criteria: Low Back Pain. 3 Figure 3. “Red flags” for potentially serious underlying causes of low back pain. [jaoa.org]

• Low Back Pain

  The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity. [ncbi.nlm.nih.gov]

  “Red flags” for potentially serious underlying causes of low back pain. Adapted from ACR Appropriateness Criteria: Low Back Pain. 3 Figure 3. “Red flags” for potentially serious underlying causes of low back pain. [jaoa.org]

• Spine Pain

  Thoracic disc herniation presents most commonly as chest pain or spine pain, and occasionally in numbness, weakness, or spasticity. [uclahealth.org]

  Low back pain and/or leg pain (sciatica) are the most common symptoms of a herniated disc in the lumbar (lower) spine. Pain may vary from mild to severe. [treatingpain.com]

  Pain moving your neck Deep pain near or over your shoulder blade Radiating pain in your upper arm, forearm, and possibly your fingers Pain from a bulging disc may start slowly and get worse over time or during certain activities. [depuysynthes.com]

  See separate leaflet called Back and Spine Pain for a general overview of the different types of back pain .) The most common age to develop a prolapsed disc is between 30 and 50 years. Twice as many men as women are affected. [patient.info]

• Paravertebral Muscle Spasm

  On physical examination a compensatory gait, paravertebral muscle spasm, and a restricted right straight-leg raising test were demonstrated. Plain x-ray films revealed a narrowed L4–5 intervertebral space. [thejns.org]

  Change of Gait -Severe paravertebral muscle spasm changes gait. Gait change follows postural abnormality, muscle weakness and atrophy of lower leg muscles. [epainassist.com]

• Acute Low Back Pain

  How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med. 1986;315:1064–70. 17. Malmivaara A, Hakkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, et al. [aafp.org]

  DC, PT: Comparison of Classification-Based Physical Therapy With Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back Pain: A Randomized Clinical Trial. Spine. 2813:1363-1371, July 1, 2003. [hss.edu]

  Spinal Manipulative Therapy and Mobilization - Spinal manipulative therapy and mobilization leads to short-term pain relief when suffering from acute low back pain. [physio-pedia.com]

• Claustrophobia

  Three patients did not undergo MRI because of claustrophobia and were excluded. Two more patients were excluded because their data were not available. Data for one patient were incomplete: Four segments were evaluated instead of six. [ajronline.org]

• Sciatica

  Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status. [ncbi.nlm.nih.gov]

  Sciatica is a common diagnosis in the general population. Sciatica is most frequently caused by LDH. [sogacot.org]

  Sciatica due to a herniated lumbar intervertebral disk is common and has an estimated point prevalence of roughly 5% in the general adult population. 1 Numerous prospective studies have reported excellent recovery of acute sciatica in the absence of significant [cmaj.ca]

• Paresthesia

  A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms. [nejm.org]

  CLINICAL FEATURES: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. [ncbi.nlm.nih.gov]

  His history was significant only for a spontaneous onset of lumbar back pain noted immediately after awkward bending six months prior, followed two to three days later by severe leg pain, paresthesias and ankle weakness, consistent with an L5 radiculopathy [cmaj.ca]

• Foot Drop

  Foot drop is defined as inability to dorsiflex the foot at the ankle joint. [ncbi.nlm.nih.gov]

  In those with severe extensor weakness, especially painless foot-drop, diskectomy does not improve the outcome.” Discrimination between foot drop and severe extensor weakness may not be possible or reasonable. [healio.com]

  Weakness in the foot is especially common, with difficulty lifting the foot (known as foot drop) often reported in those with L4/L5 herniation. [sportsinjuryclinic.net]

• Limb Weakness

  Additions symptoms of lumbar spondylosis include: Localized pain Pain after prolonged sitting Worsening pain after repeated movement Muscle spasms Regional tenderness Tingling, numbness in the limbs Weakness of affected limb due to possible nerve compression [bodhiwellnesscentre.com]

  We report a 45-year-old male who presented with sudden onset right lower limb weakness after lifting heavy weight. Magnetic resonance imaging of the cervical spine showed C5/6 disc prolapse with intradural extension. [read.qxmd.com]

• Neuralgia

  […] non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Disorder (of) - see also Disease disc (intervertebral) M51.9 Neuritis (rheumatoid) M79.2 ICD-10-CM Diagnosis Code M79.2 Neuralgia [icd10data.com]

  Community Wiki Code: M54.16 Code Name: ICD-10 Code for Radiculopathy, lumbar region Block: Other dorsopathies (M50-M54) Excludes 1: current injury - see injury of spine by body region discitis NOS (M46.4-) Details: Radiculopathy, lumbar region Excludes1: neuralgia [aapc.com]

[…] invasive Plain lumbar films: Generally not helpful in the diagnosis, except to rule out other diseases and to evaluate for possible skeletal etiology as the cause of the patient's symptoms Bone scanning: To rule out tumors, trauma, or infection See Workup [emedicine.medscape.com]

In group A, treatment was a success (excellent or good outcome) in 70.3% and deemed a failure (poor outcome or recourse to surgery) in the remaining 29.7%. In group B, treatment was a success in 78.3% and deemed a failure in the remaining 21.7%. [ncbi.nlm.nih.gov]

In patients with chronic or recurrent disk herniation, the prognosis for recovery from pain or dysfunction is often poor. [ncbi.nlm.nih.gov]

[…] symptoms of: Back pain that spreads down the front of the leg into the knee You may have weakness when flexing at the hip or extending the knee Feeling may be decreased or reduced over the front of the thigh and the inside part of the calf Treatment and Prognosis [pagelaw.com]

Prognosis for sphincter recovery after operation for cauda equina compression owing to lumbar disc prolapse. Br Med J (Clin Res Ed). 1981; 282(6279):1852-1854. Tay EC, Chacha PB. [healio.com]

Abstract The authors have retrospectively studied the trends in etiology, symptoms, and rate of recurrence for adolescents with disk herniations to determine the age at onset of symptoms, mechanism of injury, familial history, pattern of symptoms, level [ncbi.nlm.nih.gov]

[…] years of age 5 with a male-to-female ratio of 2:1. 6 In persons 25 to 55 years of age, about 95 percent of herniated disks occur at the lower lumbar spine (L4–5 level); disk herniation above this level is more common in persons older than 55 years. 7, 8 Etiology [aafp.org]

Discal etiology can be suggested by clinical observation in patients complaining of classical lower back pain, but not excluded even without musculoskeletal pain. [read.qxmd.com]

[…] scanning: Useful but less sensitive than MRI Myelography: May provide definitive diagnosis itself, but technique is invasive Plain lumbar films: Generally not helpful in the diagnosis, except to rule out other diseases and to evaluate for possible skeletal etiology [emedicine.medscape.com]

It is important for both patients and spine surgeons to understand epidemiology trends and outcomes of revision surgery for real recurrent lumbar disk herniation (real-RLDH). [ncbi.nlm.nih.gov]

Epidemiology of spinal disorders. In: Frymoyer JW, Ducker TB, Hadler NM, et al., eds. The adult spine: principles and practice. New York: Raven Press, 1997:93–141. 5. Heliovaara M. Epidemiology of sciatica and herniated lumbar intervertebral disk. [aafp.org]

Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg AM. 2006;88(2):3-9. Institute for Quality and Efficiency in Health Care (IQWiG). Slipped disk: overview. 2014; n.pag. [paindoctor.com]

Epidemiology The lifetime prevalence of low back pain is 80%, with disk disorders being the most common cause of adult low back pain. [emedicine.medscape.com]

Abstract To better understand the pathophysiologic mechanisms underlying spinal nerve root injury induced by lumbar disk herniation (LDH), comparative proteomic analysis of cerebrospinal fluid (CSF) between patients with LDH (the experiment group) and [ncbi.nlm.nih.gov]

Pathophysiology The disc consists of the annulus fibrosus (a complex series of fibrous rings) and the nucleus pulposus (a gelatinous core containing collagen fibers, elastin fibers and a hydrated gel)[10]. [physio-pedia.com]

So many largely unknown or poorly understood factors are involved in the pathophysiology of this disease that the right treatment is very difficult to pinpoint; this is the main reason so many treatments are continuously proposed. [ajnr.org]

It is essential to pay careful attention to prevent a dural tear. Patients may expect clinical outcomes similar to those following primary discectomy. [ncbi.nlm.nih.gov]

Can lumbar disk disease be prevented? Maintaining a healthy weight, participating in regular exercise, and using good posture can lessen your risk for lumbar disk disease. [hopkinsmedicine.org]