Pelvis/Perineum — MCQs

Q: A slipped disc at the level shown in the image would most likely involve which nerve root?

L5. ***L5*** - The image shows a **disc herniation** at the L4-L5 level. In cases of disc herniation, it is the **nerve root exiting below the level of the disc** that is typically compressed. - For an L4-L5 disc herniation, the **L5 nerve root** is the one most commonly affected because it passes directly behind the L4 vertebral body and the L4-L5 disc before exiting the neural foramen at the L5-S1 level. *L4* - An L4 nerve root compression would typically occur with a disc herniation at the **L3-L4 level**. The L4 nerve root usually exits above the L4-L5 disc. - While sometimes L4 nerve root can be involved in a massive central L4-L5 herniation, it is less common than L5 involvement for a typical posterolateral herniation at this level. *S1* - The S1 nerve root would be involved in a **disc herniation at the L5-S1 level**, as it exits below the L5-S1 disc. - The disc herniation visible in the image is clearly above the L5-S1 intervertebral space. *L3* - Compression of the L3 nerve root usually results from a disc herniation at the **L2-L3 level**, which is higher than the level depicted in the image. - The L3 nerve root is anatomically shielded from an L4-L5 disc herniation. *L2* - The L2 nerve root would be affected by a disc herniation at the **L1-L2 level**, which is significantly higher than the level shown in the image. - L2 nerve root involvement would present with different clinical features (primarily hip flexion weakness and sensory changes in the anterior thigh).

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