Lumbar Spine: Common Pathology and Interventions

Andrea Strayer

J Neurosci Nurs. 2005;37(4):181-193. 

In This Article

Case Study

MD is a 26-year-old female with an 8-week history of low back and right posterior leg pain, subjective leg weakness, and numbness of the posterior thigh, calf, and lateral foot. Upon presentation, her back pain had nearly resolved, and her weakness had markedly improved. Her pain was aggravated by activity and alleviated by periods of rest. She described her pain as a nagging, aching, burning pain that radiated from her right buttock into her posterior thigh and calf, and extended to her lateral right foot. She had undergone epidural steroid injections, participated in a regular regime of low back stabilization exercises, and taken NSAIDs daily.

  • Social history: Graduate student, new to the city and the university. Single, previously very active, nonsmoker, social alcohol use.

  • Past medical history: No past medical problems.

  • Past surgical history: Left knee surgery, remote.

  • Medications: Naproxen.

  • Allergies: No known drug allergies.

  • Review of systems: Unremarkable.

The neurological examination indicated a decreased sensation to pin prick and light touch in the posterior thigh, calf, and lateral foot on the right lower extremity. Left lower extremity sensation was intact. Bilateral lower extremity strength was intact. She was able to walk heel and toe without difficulty. Knee and ankle jerk reflexes also were normal bilaterally. Her right lower extremity exhibited positive straight leg testing at 45 degrees. A review of her MRI scan revealed a large herniated disc at the L5-S1 level on the right, compressing the right S1 nerve root (Figs 8, 9).

MD underwent an L5-S1 right microdiscectomy for excision of a large herniated nucleus pulposus. Four weeks after surgery she had complete resolution of her symptoms. At 6 weeks after surgery she was instructed to begin a muscle strengthening program.