The red herring in disc herniation with severe nerve deficit and when should we not operate them

3^rd Global Experts Meeting on Medical Case Reports

May 09-10, 2016 New Orleans, USA

Balachandar Gopalan

American Hospital, Dubai

Posters & Accepted Abstracts: J Clin Case Rep

Abstract :

A 77-year-old gentleman presented with sudden onset pain in the right knee since three weeks followed by buckling of the right knee a week later while attempting to stand. He had an unremarkable medical history, led an active lifestyle and had no other joint pains elsewhere. He was a non-smoker and non-alcoholic. The motor power of right knee extensors and hip adductors was medical research council (MRC) grade 1, hip flexors and abductors grade 3 and other muscle groups were normal grade 5. There was reduced sensation over anterolateral right thigh with absent knee jerk reflex.Radiographs of thigh and spine were normal. MRI of lumbar spine showed L2-3 and 3-4 disc extrusion causing thecal compression, L4-5 disc protrusion and post contrast enhancement on right sided L2-3, 3-4 nerve roots. Discrepant clinical picture and MRI findings prompted electrophysiological studies which revealed femoral neuropathy on right side. A consult with spine specialist (who advised surgical removal of the disc urgently) and a consult with neurologist (who advised conservative management) further added to the conundrum. On initial therapy with intravenous followed by oral steroids for a month the patient recovered rapidly. At four months, he recovered power in all muscle groups to grade 5. At one year he was completely fine except for absent knee jerk. Although treated based on conjectural diagnosis of lumbosacral plexitis, then thought to be due to be incited by the extruded disc, a clear mapping of the neurological temporal improvement every month, it was deduced to be an entirely different entity called chemical radiculitis. This disease is very rare and the combination of upper lumbar disc herniation and picture of lumbosacral radiculoplexopathy only confounded the clinical scenario. This case serves as an important reminder of not to operate all disc herniations with nerve deficits.

Biography :

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