(1)
Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
4.1 Case Presentation
A 32-year-old female presents with a 2-day history of exacerbation of her chronic low back pain, left leg numbness, and a foot drop . She had a previous lumbar discectomy at the left L5-S1 11 years ago. No loss of bowel or bladder function. No history of trauma . She has smoked cigarettes half pack per day for 6 years.
On examination: left TA 2, EHL 2, eversion 3, inversion 2, plantar flexion 5, and toe flexion 5. The remaining muscle groups are normal. Sensation is diminished to light touch and pinprick over the left dorsum of the foot and the outer leg. DTRs: 2+ and symmetric. Straight leg raise test is positive at 30° on the left. There is tenderness over the lower back.
Fig. 4.1
4.2 Questions
- 1.
What is the differential diagnosis? What is the most likely diagnosis?
- 2.
What tests do you want to order?
- 3.
What is the treatment?
Answers
- 1.
- 2.
MRI of the lumbar spine
