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Cervical disc herniations most often present with neck and arm pain resulting from direct nerve root compression from a paramedian or foraminal disc herniation. It is unusual to encounter unilateral lower extremity symptoms in the absence of other neurological symptoms due to a centrally herniated cervical disc. Because this clinical presentation is uncommon, there can be misdiagnosis, or delay in treatment of patients who suffer from debilitating pain or weakness. We treated a patient who presented with acute progressive unilateral lower extremity weakness and paresthesia from a large herniated cervical disk. His lower extremity symptoms resolved post-operatively after undergoing anterior cervical discectomy and fusion. This case provides an example of the importance of neuroanatomical knowledge in surgical decision-making; clinicians should recognize that unilateral leg weakness can result from cervical disc herniation in absence of other neurological symptoms.

In the last 25 years, scientific research has brought about drastic changes in the concept of low back pain and its management. Most imaging findings, including degenerative changes, reflect anatomic peculiarities or the normal aging process and turn out to be clinically irrelevant; imaging tests have proven useful only when systemic disease is suspected or when surgery is indicated for persistent spinal cord or nerve root compression. The radiologic report should indicate the key points of nerve compression, bypassing inconsequential findings. Many treatments have proven inefficacious, and some have proven counterproductive, but they continue to be prescribed because patients want them and there are financial incentives for doing them. Following the guidelines that have proven effective for clinical management improves clinical outcomes, reduces iatrogenic complications, and decreases unjustified and wasteful healthcare expenditures.

Magnetic resonance imaging is established as the technique of choice for assessment of degenerative disorders of the lumbar spine. However, it is routinely performed with the patient supine and the hips and knees flexed. The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion-extension, in the erect position or by using axial loading. This article reviews the literature relating to the above techniques.

The burner syndrome is the result of two distinct injury patterns: brachial plexus stretch injury and cervical nerve root compression. This clinical entity is discussed with emphasis on diagnosis and management. A review of the literature is included.

The technique of limited surgical discectomy allows the removal of a herniated lumbar disc through a limited surgical approach while permitting adequate nerve root compression. Formal laminectomy and excessive disc removal is avoided. This limited surgical technique results in full neurological decompression and resolution of sciatic symptoms while preventing any long-term instability or symptoms due to unnecessary surgical trauma.

The relationship between a herniated lumbar disc and nerve root compression is well described. The surgical treatment has evolved over the last several decades. Presently, surgical treatment offers a highly predictable and successful outcome in properly selected patients. This report discusses the indications, techniques, and results of limited discectomy for herniated lumbar disc disease.

The posterior surgical approach to nerve root compression remains a safe, effective method of relieving the pain of cervical nerve root compression and of restoring function. Myelopathy, often caused by extensive cervical spondylosis associated with a small cervical canal, may be reversed or alleviated by adequate posterior decompression.

Summary Sciatica, when defined as pain radiating from the back along the course of the sciatic nerve, is nearly always due to intervertebral disc disease. All the other causes of sciatica and similar pain are rare but ought to be considered, particularly when the symptoms are atypical. In most instances the diagnosis of nerve root compression can be made clinically. X-ray examination and myelography serve to confirm the clinical diagnosis. Electromyography, in our experience, has not much to contribute in the differential diagnosis of sciatica.