Disc herniation presents with radicular pain and a positive straight-leg raise, with MRI showing disc protrusion or extrusion. Which condition is described?

Disc herniation presents with radicular pain and a positive straight-leg raise, with MRI showing disc protrusion or extrusion. Which condition is described?

• A. Spondylolysis
• B. Disc herniation
• C. Spinal stenosis
• D. Spondylolisthesis

Answer: (B)

Radicular pain with a positive straight-leg raise points to nerve root irritation or compression in the lumbar spine. When MRI shows disc material bulging beyond the disc space either as a protrusion or as an extrusion, this indicates a herniated disc pressing on nearby nerve roots as they exit the spinal canal. The straight-leg raise reproduces pain by tensioning the affected nerve root, which is commonly seen with lumbar disc herniation at levels such as L4–L5 or L5–S1. Other conditions don’t typically present with this exact combination: spondylolysis is a pars interarticularis stress fracture with localized back pain and no classic radicular pattern; spinal stenosis causes diffuse neurogenic claudication and leg symptoms that arise with walking rather than a focal positive straight-leg raise; spondylolisthesis involves vertebral slippage and may cause nerve compression, but the imaging description here centers on disc material herniating rather than vertebral misalignment. Thus, the described scenario is best explained by a disc herniation.

Radicular pain with a positive straight-leg raise points to nerve root irritation or compression in the lumbar spine. When MRI shows disc material bulging beyond the disc space either as a protrusion or as an extrusion, this indicates a herniated disc pressing on nearby nerve roots as they exit the spinal canal. The straight-leg raise reproduces pain by tensioning the affected nerve root, which is commonly seen with lumbar disc herniation at levels such as L4–L5 or L5–S1. Other conditions don’t typically present with this exact combination: spondylolysis is a pars interarticularis stress fracture with localized back pain and no classic radicular pattern; spinal stenosis causes diffuse neurogenic claudication and leg symptoms that arise with walking rather than a focal positive straight-leg raise; spondylolisthesis involves vertebral slippage and may cause nerve compression, but the imaging description here centers on disc material herniating rather than vertebral misalignment. Thus, the described scenario is best explained by a disc herniation.