The L4-L5 intervertebral disc is the most commonly symptomatic lumbar disc level, producing L5 nerve root compression when posterolateral herniation occurs. It is the pivot point of lumbar flexion and bears the highest annular stress in the lumbar spine.
L4-L5 disc herniation is the most common cause of L5 radiculopathy with foot drop, weak toe extension and hip abduction, and reduced ankle reflexes. The disc level is confirmed by MRI demonstrating disc material compressing the L5 root in the lateral recess or foramen. Microdiscectomy at L4-L5 has the highest success rate of any lumbar disc surgery due to the reliable anatomy and accessible approach.
Posterolateral L4-L5 disc prolapse compressing the L5 nerve root producing foot drop, lateral leg and dorsal foot numbness, and weak big toe extension, treated by microdiscectomy with 85-90% success.
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