A 32-year-old male elite athlete was lifting heavy weights during an intense training session. The athlete felt severe pain radiating to the posterior aspect of his right thigh and leg. The patient was taken to the hospital where MRI revealed a ruptured L4/L5 intervertebral disk. Which nerve is most probably affected?
In the lumbar region spinal nerves exit the vertebral column below their named vertebrae. In an L4, L5 intervertebral disk herniation, the L5 spinal nerve would be affected as it descends between L4, L5 vertebrae to exit below the L5 level. L2, L3, and L4 spinal nerves have already exited above the level of herniation; therefore, they would not be affected by this herniation. An "L6" spinal nerve normally does not exist. (The NBME does not allow "made up" structures, but in cases of lumbarization of S1, some people recognize an L6 nerve.)
L3
L4
L2
L5
Upper Extremity