A 45-year-old construction worker presents with L5 radiculopathy (footdrop, numbness in L5 distribution) following a work injury. MRI confirms a large L4-L5 disc extrusion compressing the L5 nerve root. Conservative management for 6 weeks failed. The indication for surgical discectomy in this patient is:

• A Persistent radiculopathy alone for 6 weeks without motor deficit
• B The patient must fail 12 weeks of conservative treatment regardless of neurological status
• C MRI evidence of disc herniation without clinical symptoms is sufficient indication
• D Progressive motor deficit (footdrop), failed conservative management — urgent surgical decompression indicated ✓

Explanation

Absolute surgical indications for lumbar disc herniation include: cauda equina syndrome (emergency), progressive motor deficit (any grade 3 or below muscle power with evidence of deterioration), or significant motor deficit persisting >6 weeks. Footdrop (L5 palsy, grade ≤3 EHL/tibialis anterior) with failed 6-week conservative management constitutes a surgical emergency — delay beyond 4-6 weeks of complete motor deficit risks permanent deficit. Relative indications include persistent disabling radicular pain after 6 weeks of conservative treatment. MRI findings alone without symptoms are not an indication.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.