A 45-year-old construction worker presented to the medical OPD with sudden acute low back pain radiating to the left leg with inability to lift the big toes. The best management would be
Ans. B. The appearance of foot drop would be an early indication for surgical interventionThe clinical symptoms and signs in the case described in this question point to compression of the 5th lumber nerve root, of all lumbar herniations, 95% occur at L4-5 or Ls,SI interspace.a. Strict bed rest on a firm mattress and use of analgesics, relaxants and focally applied heat constitute appropriate initial treatmentb. Because - back-strengthening exercise would aggravate acute symptoms, they should be started only after the pain has subsided.c. Surgical treatment should be reserved for those patients who have significant neurologic deficits, such as bladder or bowel dysfunctions or footdrop, and those with disabling episodes of pain failure to respond to initial conservative treatment also, can be an indication for surgeryd. Fusion of vertebral bodies - for treatment of residual back pain following laminectomy has not met with much success.