Clinical features

The clinical features of prolapsed intervertebral disc are:

• back pain with very limited movement
• usually in a fit young adult
• sudden onset while lifting or stooping
• inability to straighten up: lumbar lordosis may be lost and there may be a protective sciatic scoliosis
• pain felt in leg and buttock - sciatica - may be a day or two later
• worsened by coughing and straining
• may be paraesthesia or numbness in the leg or foot
• urinary retention may result if cauda equina compression - this is a surgical emergency
• tenderness in the midline of the lower back
• pain may be worsened by foot dorsiflexion and bowstringing of the popliteal nerve
• sometime "crossed sciatic tension" - sciatic pain in the affected leg on raising the unaffected leg

Reference

1. Low back pain and sciatica in over 16s: assessment and management. NICE Guidelines (November 2016 - last updated December 2020) NG59