![]() However these mechanisms have not been widely accepted. ( 10) in his series of 5 patients with paracentral disc herniation, suggested a similar mechanism resulting in compression of the contralateral nerve root against the facet joint. ( 13) proposed that inconsistent dural attachments to the posterior longitudinal ligaments holds the lumbar nerve roots at certain levels resulting in a more symptomatic traction of the contralateral nerve root. The mechanism for lumbar disc herniation presenting with contralateral leg symptoms is poorly understood ( 10, 11). This phenomenon suggests that the disc herniation at L5/S1 is indeed the cause of patient’s symptoms despite being on the contralateral side. To the best of the author’s knowledge, this case is unique because a successful foraminal block delivered on the symptomatic side not only re-localizes the leg symptoms to the side of lesion, but also gave transient relief to the patient’s symptoms. Despite the fact that several cases have been reported in the literature of patients who presented with contralateral leg symptoms ( 10- 12), it remains difficult to recommend surgery in general to these patients with discordant symptoms. Surgery may be indicated in selected patients who are refractory to conservative management if leg symptoms are concordant with MRI scans ( 5). Radiculopathy from lumbar disc herniation can be a result of mechanical compression ( 8), ischaemia ( 8) or inflammatory irritation ( 9) of the nerve root. His left leg symptoms resolved completely after the surgery up to 1 year of follow-up. A repeat MRI was not performed as there was no precipitating event or inciting trauma during this period. Given the concordance between his current clinical symptoms and the MRI findings this time, he underwent a left L5/S1 microdiscectomy. Straight leg raise was positive at 40 degrees on the left side. Neurological examination of his lower limbs was normal. There was again no precipitating event or inciting trauma. This was associated with paresthesia over his left posterior thigh. Six weeks after the foraminal block, the patient presented with a 5-day insidious onset of low back pain radiating down his left posterior thigh and leg. He had complete resolution of the pain in his right lower limb and went back to work for the next 6 weeks. The foraminal block was performed successfully with Shincort and Marcaine in a 1:1 ratio (total 3 mL) under fluoroscopic guidance. There was no abnormality in the facet joints or the ligamentum flavum.Īs the symptoms were on the right side, the patient was counseled for a right L5/S1 foraminal block for both diagnostic and therapeutic purposes. There was no prolapsed disc seen on the right side or at the L4/5 level despite evidence of disc degeneration ( Figure 3). MRI of his lumbar spine showed a left-sided paracentral disc herniation at L5/S1 causing stenosis of the left lateral recess ( Figures 1, 2). Upon review at 6 weeks, his symptoms did not improve. He was managed conservatively with physiotherapy and analgesia. Plain X-rays of the lumbar spine was normal. Straight leg raise was negative bilaterally. Examination revealed weakness in the right flexor hallucis longus of grade 4, with an otherwise normal neurological examination. He did not have any associated lower limb paresthesia or weakness, and did not have any bowel or bladder incontinence. The patient did not recall any inciting trauma. We report a unique case of left lumbar disc herniation at L5/S1 who presented with right-sided symptoms and successfully treated with a right L5/S1 foraminal block.Ī 24-year-old gentleman who worked as a bellboy, presented with a 5-month history of low back pain radiating down his right buttock, posterior thigh and posterior leg. In such cases, surgery should be avoided. Contralateral leg symptoms cast doubt on the diagnosis as many herniated discs are asymptomatic ( 2, 3). ![]() Although it is often diagnosed clinically, an MRI is needed to confirm the diagnosis and localize the pathology prior to any forms of intervention ( 6, 7). It usually presents with varying degrees of pain, numbness and weakness in the distribution of the affected nerve root ( 4, 5). Lumbar disc herniation is common ( 1- 3) and may be symptomatic ( 1, 4). ![]() Keywords: Prolapsed disc herniated disc intervertebral disc displacement nerve root inflammation nerve root disorder Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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