Himalaya: Listen. Learn. Grow.
Spine & Nerve podcast
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas present a case report and do a quick review of lumbar disc herniations.
Dr. Karvelas presents a case in which a more cephalad lumbar disc herniation can effect nerve roots more than 1 level caudal to the level of disc herniation. For example typically we would expect a L3-4 disc herniation to impact the L4 or L3 nerve root, but there are cases where the more caudal nerve roots (for example L5) can be impacted.
The docs start by taking a step back and review the anatomy of the lumbar disc, and some important information regarding lumbar disc herniations including definitions and risk factors.
It is well researched and documented that the most common lumbar disc herniation is a posterolateral disc herniation that would effect the traversing nerve root exiting one level caudal to level of herniation. However, when a patient's symptoms and neurologic exam do not fit with this classic picture it is important to keep an open mind to the differential diagnosis including but not limited to the possibility of more caudal nerve roots being involved.
Listen as the doctors not only present there own recent case in clinic, but also review the case reports in the literature documenting clinical instances where a lumbar disc herniation has resulted in a more rare clinical presentation for a patient. This discussion reinforces an important principle in medicine that we always want to emphasize: in medicine it is important that we work as hard as we can to determine the most likely cause of the problem, but then importantly keep our mind open to/and think critically through other possibilities.
1. Mekhail N, Costandi S, et al.The Impact of Tobacco Smoking on Spinal Cord Stimulation Effectiveness in Complex Regional Pain Syndrome Patients. Neuromodulation. 2020; 23: 133-139.
This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.