Extreme lateral lumbar disc herniation. Diagnosis and management

Extreme lateral disc herniation accounts for about 10% of lumbar disc ruptures and is more common in the elderly. Patients will frequently complain of pain in the groin and anterior thigh but little if any back pain. Because the L4 root is often involved, the physical exam often shows quadriceps weakness and a diminished patellar reflex. Other important signs include a negative Lasèque's sign and reproduction of pain with lateral bending of the back toward the involved extremity. Currently, CT or MRI are the diagnostic procedures of choice. The initial treatment for extreme lateral disc herniation is bed rest and NSAIDs with surgery if conservative therapy fails. Primary care physicians should consider extreme lateral disc herniation when they evaluate patients with low back and leg pain.