Describe the classic presentation of a patient with a herniated nucleus pulposus

Describe the classic presentation of a patient with a herniated nucleus pulposus.

The average age of patients presenting with herniated discs is 30–50 years. The pain is primarily in the back and posterior aspects of the legs and typically occurs after lifting heavy objects. It is caused by either mechanical compression of nerve roots or chemical injury from substances released by degenerating intervertebral discs (e.g., phospholipase A). The nerve roots affected determine the distribution of the pain. The pain is aggravated by bending, coughing, or sneezing and is improved with resting and lying down. Motor or sensory deficits depend on the level and extent of nerve involvement. Rarely, bowel or bladder dysfunction can occur. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are invaluable in confirming the diagnosis. However, imaging must be correlated with clin-ical symptoms because positive findings on scans may not necessarily be related to symptoms.

Physical examination demonstrates increased pain when tension is applied to the lumbosacral plexus. Thus, tests such as the bowstring sign (radicular pain elicited by popliteal pressure), Gower’s sign (radicular pain secondary to foot dorsiflexion), and radicular pain with straight leg raising are indicative of nerve irritation.