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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 is almost always absent. Extension of the great toe against resistance will show weakness of the extensor hallucis
longus. This indicates nervous involvement. After first attack there may not be any X-ray changes. But after many months or years with subsequent attacks there will be narrowing of the
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 is almost always absent. Extension of the great toe against resistance will show weakness of the extensor hallucis
longus. This indicates nervous involvement. After first attack there may not be any X-ray changes. But after many months or years with subsequent attacks there will be narrowing of the
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