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Clinics in neurology and neurosurgery of sport: lumbar spine. Sequestrated disc prolapse and disc bulge
  1. G Davis1,
  2. E Johnson2,
  3. P C McCormick3,
  4. E P Roger4,
  5. K Ugokwe5,
  6. E C Benzel6,
  7. W R Sears7,
  8. P McCrory8
  1. 1
    Cabrini Medical Centre, Malvern, Victoria, Australia
  2. 2
    Columbia University College of Physicians and Surgeons, New York, New York, USA
  3. 3
    Department of Neurosurgery, Columbia Spine Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
  4. 4
    Cleveland Clinic Spine Institute, Cleveland, Ohio, USA
  5. 5
    Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
  6. 6
    Cleveland Clinic Spine Institute, Neurosurgical Residency Programme, Cleveland Clinic, Cleveland, Ohio, USA
  7. 7
    Neurosurgeon to the Spinal Injuries Unit, Royal North Shore Hospital and Departments of Neurosurgery, Royal North Shore and Dalcross Private Hospitals, Sydney, Australia
  8. 8
    Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia
  1. Correspondence to Associate Professor P McCrory, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia 3010; p.mccrory{at}unimelb.edu.au

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Focal degenerative disc disease in the lumbar spine is broadly categorized into three clinical types: (1) asymptomatic disc degeneration, (2) degenerative disc disease resulting in low back pain (LBP) and (3) focal disc prolapse resulting in compression of the spinal nerve root producing the clinical picture of radiculopathy or sciatica. Whenever possible, non-surgical management is the favoured option, but when persistent nerve root compression does not respond to conservative measures, surgical decompression of the nerve root is required. A variety of operative procedures and approaches exists to deal with focal disc prolapse. Such procedures include open discectomy, microdiscectomy and endoscopic percutaneous discectomy. In some situations, in addition to discectomy, a vertebral fusion procedure is also required.

Although the fine details of surgical technique are beyond the scope of this paper, two cases have been selected for discussion because they represent common clinical scenarios encountered by the spinal surgeon, but there is limited published information specific to the athlete with such an injury. We have therefore addressed the issues specific to return to sport rather than focus on the myriad surgical procedures that can be performed on the lumbar spine.

Case study: patient 1. Lumbar: sequestrated disc prolapse

A 29-year-old American footballer was tackled to the ground and instantly felt a “twinge” in his lower back. He got up from his fall, and over the next few hours the pain intensified and then radiated into his right thigh, calf and foot. Treatment over the following 4 weeks included physiotherapy, acupuncture, non-steroidal anti-inflammatory medication, and hydrotherapy. The leg pain intensified and MRI of the lumbar spine showed a right L5–S1 sequestrated disc prolapse (figs 1 and 2). A microdiscectomy was performed, with complete resolution of pain. He was discharged from hospital the day after surgery and has remained free of pain. You review him 6 weeks postoperatively and he is …

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