Extreme lateral ruptures of lumbar intervertebral discs

Several cases are presented of extreme lateral rupture of the lumbar intervertebral disc in which symptoms of localized nerve root compression were not manifest and in which myelography was negative or misleading. Ordinary exploration techniques failed to disclose these lesions. The most striking pain patterns seen in these patients were flank pain, gluteal, groin, and sometimes upper anterior thigh pain, induced or aggravated by back motion. This pain, plus radiating leg pain, when it occurred, was generally exceedingly severe and disproportionate to the neurological deficit. Lumbar discography was useful in detecting these ruptures.