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Prolapsed disc may press on the duramater causing backache or on the nerve roots causing backache or sciatica or both. The prolapse of a disc occurs nearly
always just above or below the 5th lumbar vertebra (i.e. between L4 and L5 or L5 and S1). As oedema subsides the prolapsed disc may shrink or slip back
into place. Sometimes it may not be absorbed and becomes adherent to root sheaths. Long standing prolapse may disturb the mechanism of the intervertebral
joints. The first attack is often sudden in onset and occurs while lifting weight from bent position. The patient complains of excruciating backache and
sciatica may or may not follow soon after. The symptoms subside in a few days or weeks. Sciatica is at first locate in the buttock but it soon spreads
to the thigh, leg along the posterior aspect even upto the toes. Subsequent attacks are also sudden in onset but may follow trivial injury such as coughing
etc. On examination,. the patient is found to stand with a characteristic attitude - lumbar scoliosis with convexity to the affected side. kyphosis and
slight flexsion of the hps and knees. Local deep tenderness is elicited on or slightly lateral to the affected spine. Pressure on the jugular vein often
induces pain over the lesion (Naffziger's test). Flexion and extension of the spine are greatly restricted. Lateral flexion on the side of the lesion
is also very painful, but rotation may be free and painless. Knee jerk may be diminished (in case of lesion between L3 and L4), but tendo Achillis jerk
always just above or below the 5th lumbar vertebra (i.e. between L4 and L5 or L5 and S1). As oedema subsides the prolapsed disc may shrink or slip back
into place. Sometimes it may not be absorbed and becomes adherent to root sheaths. Long standing prolapse may disturb the mechanism of the intervertebral
joints. The first attack is often sudden in onset and occurs while lifting weight from bent position. The patient complains of excruciating backache and
sciatica may or may not follow soon after. The symptoms subside in a few days or weeks. Sciatica is at first locate in the buttock but it soon spreads
to the thigh, leg along the posterior aspect even upto the toes. Subsequent attacks are also sudden in onset but may follow trivial injury such as coughing
etc. On examination,. the patient is found to stand with a characteristic attitude - lumbar scoliosis with convexity to the affected side. kyphosis and
slight flexsion of the hps and knees. Local deep tenderness is elicited on or slightly lateral to the affected spine. Pressure on the jugular vein often
induces pain over the lesion (Naffziger's test). Flexion and extension of the spine are greatly restricted. Lateral flexion on the side of the lesion
is also very painful, but rotation may be free and painless. Knee jerk may be diminished (in case of lesion between L3 and L4), but tendo Achillis jerk
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