Low lumbar disc prolapse

Case presentation

A 40-year-old builder presents with a two-day history of severe low lumbar pain following a lifting and twisting injury at work. Rest is advised, but he undergoes a series of chiropractic manipulations. His back pain suddenly disappears and is replaced by pain in the right buttock, posterior thigh and posterior calf. He also has numbness on the outer and under surfaces of the right foot.

The relevant physical findings are: a loss of lumbar lordosis and a list to the left, marked restrictions of lumbar movement, marked restriction of straight leg raising (which reproduces his pain), and an absent right ankle jerk.