The L4-L5 intervertebral disc is the most commonly herniated disc in the lumbar spine, with the L5 nerve root most frequently compressed (producing pain radiating to the lateral leg and dorsal foot). The disc is composed of the outer anulus fibrosus (concentric fibrocartilage rings) and the inner nucleus pulposus (hydrophilic proteoglycan gel). Disc degeneration begins with nuclear dehydration, producing loss of disc height and increased radial anular stress.
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L4-L5 disc herniation most commonly involves posterocentral or posterolateral protrusion compressing the traversing L5 root in the lateral recess. Symptoms include lateral leg pain and dorsal foot numbness with weakness of great toe extension (EHL), and in severe cases ankle dorsiflexion weakness (foot drop) and weak hip abduction. MRI confirms the level and the relationship of disc material to the L5 root. Surgical microdiscectomy provides faster relief than conservative treatment for root compression with neurological deficit.
Posterolateral annular tear with nucleus pulposus extrusion compressing the L5 nerve root producing sciatica with EHL weakness managed with microdiscectomy.
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