Herniated nucleus pulposus: The Daily PANCE Blueprint
A 75-year-old male presents with progressively worse back pain and “tingling and numbness” that travels down his right leg. On physical exam, the right leg looks more atrophied and has diminished DTRs. Which of the following is the diagnostic test of choice?
A. Lumbar x-ray
B. Electromyography
C. Ankle-brachial index
D. MRI spine without contrast
E. CT angiography
Answer and topic summary
The answer is D. MRI spine without contrast
A disk herniation typically occurs when there is complete extrusion of the nucleus pulpous through a tear in the annulus fibrosis. Discs commonly herniate more posterior/lateral, as the ligament in those regions is thinner. The reason it usually happens is due to gradual, chronic wear and tear (e.g., disk degeneration). Clinical features may include back or neck pain, paresthesia, muscle weakness of atrophy, motor deficits (LMN or UMN signs), and even bladder and bowel issues. Cauda equina syndrome must be ruled out as this is a surgical emergency. An MRI spine is the best test. Treatment depends, typically conservative management is offered first (physiotherapy, NSAIDs, etc).
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ ⇒
