L3 l4 disc extrusion

Lumbar disc extrusion, A typical case of knee buckling,

1. A case of Knee buckling disc extrusion L3 – L4 Vinod Naneria Girish Yeotikar Arjun Wadhwani Choithram Hospital & Research Centre, Indore India

2. Case summary A 40 years old male C/o acute pain in the right knee associated with frequent fall since last 7 days. No history of trauma. He was scared to walk with out support .  Patient was limping and had insecurity while walking. Now pain was gradually reducing.

3. Clinical examination Right knee was cold, (no inflammation) no deformity, no effusion, no tenderness , no laxity and had full range of movements. Patello -femoral joint was normal .

4. Clinical examination Examination of hip: full range free movements . Spine full flexion, SLRT - negative. Ankle normal with palpable DP, & PT vessels . EHL gr 5 power, ankle jerks are normal on both sides . Unable to walk on toes and heels.

5. Clinical examination There was no wasting of any muscle. The history was only 7 days. Active quadriceps was ok but not against resistance (could be attributed due to pain). Quadriceps weakness gr 3 ? Left knee jerk was present. Right knee jerk was absent.

6. Clinical examination Testing of knee reflex and comparing with deep reflexes of other limb, click the possibility of neurological involvement. Hence I asked for MRI. My patient had doubt in mind. His pain/discomfort was in/around knee and I am asking for MRI of spine!

7. Treatment Conservative Pain was getting less. Mono- radiculopathy . Minimal neurological deficit. Least possibility of progression/or deterioration of neurology.

8. comments L3 –L4 extruded disc can be missed. Knee pain can come from spine and hip. High degree of suspicion. Through neurological examination. Comparison on two sides.

9. comments When Patient’s narration of symptoms does not match with the clinical examination, it is better to over investigate the patient . When differentiating between an L3 radiculopathy versus a femoral neuropathy, weakness in the hip adductors in addition to the quadriceps group would indicate an L3 radiculopathy.

10. DISCLAIMER Information contained and transmitted by this presentation is based on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India. It is intended for use only by the students of orthopaedic surgery. Views and opinion expressed in this presentation are personal. Depending upon the x-rays and clinical presentations viewers can make their own opinion. For any confusion please contact the sole author for clarification. Every body is allowed to copy or download and use the material best suited to him. We not responsible for any controversies arise out of this presentation. For any correction or suggestion please contact [email protected]