There is a paracentral disc prolapse at the L5/S1 level. How would you treat this patient?

Initially conservatively as the natural history of most lumbar disc prolapses is that they
resolve with time. If it has not resolved after 612 weeks of conservative management, I
would offer the patient microdiscectomy
What is the source of nutrients to the disk?
Diffusion through endplates
Contralateral straight-leg raise test?
If this test reproduces the patients sciatic symptoms in opposite extremity, it is
considered positive.
A positive test is strongly suggestive of a disc herniation medial to the nerve root (in the
axilla of the of the nerve root)
The combination of a positive SLR on the symptomatic side and a positive contralateral
SLR test is the most specific clinical test for a disc herniation, with accuracy approaching
97%
What nerve root is affected by a posterolateral disc herniation?
The nerve roots of the lumbar spine exit the spinal canal beneath the pedicle of the
corresponding numbered vertebra and above the caudad intervertebral disc
The most common location for a lumbar disc herniation is posterolateral. This type of
disc herniation compresses the traversing nerve root of the motion segment (example.,
posterolateral disc herniation at the L4-L5 level would compress the traversing nerve root
L5
Posterolateral traversing nerve root
What nerve root is affected by a disc herniation lateral to or within the neural foramen?
It compresses the exiting nerve root of the motion segment (example., a disc herniation at
the L4-L5 level located in the region of the neural foramen compresses the exiting L4
nerve root and spares the traversing L5 nerve root
Lateral/ foramen exiting nerve root
What nerve roots are affected by a central disc herniation
A central disc herniation can compress one or more of the caudal nerve roots. A large
central disc herniation is common cause of a cauda equina syndrome

theory
The clinical features and treatment options for disc prolapse vary depending on age and
the location of the prolapsed disc.
A thoracic disc prolapse (rare) will typically present with symptoms and signs of spinal
cord compression associated with thoracic back pain
A cervical disc prolapse may present with symptoms and signs of a cervical
radiculopathy or cervical myelopathy.
The knowledge that the L4 nerve root exits the spinal canal below the L4 pedicle may
(incorrectly) lead the candidate to expect the L4 nerve root to be compressed when a disc
prolapse occurs below the L4 vertebra in the L4/5 interspace