Excruciating Lower Back Pain

MRI spine showing a L4 / L5 disc herniation

An MRI spine is performed, and the image is shown

This shows a L4/L5 disc herniation

What should the next step in the management of Jane be?

Please answer each row

Well done, correct.

Correct Answer:

Surgical Decompression

Surgical management aims at preventing further neurological deficits by decompression of the spinal cord and / or nerve roots
Surgery should ideally be performed within 48 hours of symptoms onset
Early recognition and surgical decompression offer the potential for stabilisation of deficits or possible reversal

Decompression involves a bilateral laminectomy and discectomy
A laminectomy involves removing the lamina of the vertebra
This exposes the herniated disc
The herniated disc and the extruded fragments are then removed (discectomy), decompressing the nerve roots