Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features

Table 1 Clinical differences between postero-lateral and far-lateral herniations

Clinical findings	PLH	FLH
Nerve root invovled	At the level below the disc herniation	At the same level of disc herniation
Femoral stretch test	Not always significantly reliable	Markedly positive
Lateral bending	Do not reproduce radicular symptoms	Usually reproduces pain and paresthesia
Severity of pain	Variable	Strong, related to dorsal root ganglion compression

PLH: Postero-lateral herniations; FLH: Far-lateral herniations.

Table 2 Clinical picture of postero-lateral and far-lateral herniations at different levels

Root	PLH level	FLH level	Pain/radiation/sensory involvement	Motor involvement	Deep tendon reflex	Radicular stretching test
L3	L2-L3	L3-L4	Anterior aspect of the tigh	Iliopsoas and/or quadriceps	Patellar	Femoral
L4	L3-L4	L4-L5	Anterior aspect of the tigh, medial malleolus and medial foot	Quadriceps and anterior compartment fo the leg	Patellar	Femoral
L5	L4-L5	L5-S1	Postero-lateral tigh and leg	Extensor hallucis longus and dorsiflexors	None	Lasègue
S1	L5-S1		Posterior thigh and leg, foot (plantar)	Triceps surae	Achilles	Lasègue

PLH: Postero-lateral herniations; FLH: Far-lateral herniations.