Clinical History and Signs of Sciatica and their Relation to Localisation of Lumbar Disc Herniation

Abstract

INTRODUCTION: We present a neurosurgical unit’s

experience with 6 adult patients who underwent surgical

treatment for lumbar intervertebral disc herniation. The site

of sciatic pain usually depends on the nerve root affected.

Studies have shown that the clinical symptoms and the

level of disc prolapse do not always correlate each other.

The purpose of this study is to evaluate the reliability of

clinical symptoms and signs in localizing the level of disc

prolapse among patients having lumbar disc herniations.

MATERIALS AND METHODS: Patients operated in our

neurosurgery unit from 1st March 2017 to 30 April 2017 for

sciatic pain was taken for the study. The clinical history

and examination findings, radiological findings, and

operative findings were noted. The pre-operative history

and site of radicular pain and clinical examination findings

were compared with the level and position of the disc

prolapse during the surgery. RESULTS: Surgery was

performed in all six patients with sciatic pain. The mean

age of the patients with lumbar disc herniation was

41.1 years and 66.6 % were males. The levels of disc

prolapse were L4-5 in 2 patients, L5-S1 in 2, and 1 each at

the L1-2 and L3-4 levels. In four patients (83.3%) the site

of radiation of the radicular pain had good correlation with

the level of disc prolapse. Positive sign of extensor hallucis

longus (EHL) weakness with pain projection or sensory

disturbances was strong evidence of L5 root involvement.

Sensory disturbances could not accurately localize the

level of disc prolapsed. Achilles tendon reflex was a strong

indicator of S1 root involvement due to L5-S1 disc

prolapsed. CONCLUSION: Despite the routine use of MRI

to evaluate the majority of cases with suspected lumbar

degenerative disc disease, clinical evaluation remains of

paramount importance in correlating clinical and

radiological findings.