Syndrome of intradiscal lumbar herniation. Clinical presentation and management

A syndrome of intradiscal lumbar herniation not associated with nerve root compression is described. The patients have a history similar to that seen in classic disk herniation, except the paresthesias and pain are "referred" roughly in a dermatomal distribution. On examination, limitation of range of motion of the back secondary to muscle spasm is noted; however, a positive straight leg-raising test result is not. Objective neurological findings are much less obvious than with radiculopathy. These patients may have "weakness" from lack of effort on their part during the examination. There is noted asymmetry in appropriate reflexes and also in the sensory examination. Standard imaging examinations are equivocal. If explored surgically, the findings are relatively unimpressive. These patients, if correctly identified, may be candidates for percutaneous nuclectomy.