Question 9: Management
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?
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
