The diagnosis was never conclusive to me, since there was no verified bilateral nerve compression, although it is possible that some of the cauda equina is affected by a large central herniation at L5/S1. Now, I feel that my later discovered cervical herniations are more probable as the source of most of my suffering, at least structurally. One intervertebral bulge, in particular, really displaces the spinal cord severely and this may explain the incredible diversity of symptoms I endure. I place far more credence in this theory than in the lumbar disc-enactment suspicions.
() A 32-year-old man underwent a lumbar microdiskectomy and an incidental dural tear occurred. A hemilaminectomy was performed to obtain adequate visualization of the defect, and primary repair of the tear was performed. One month postoperatively he returns to the office complaining of severe headaches and occasional nausea which is worse with standing. He denies fever or chills. On physical exam his wound is well healed with no cellulitis or erythema. WBC and ESR are within normal limits. What is the most likely diagnosis? Review Topic
Transverse processes are long and slender, with changing morphology from L1 to L5. These processes are horizontal in L1-L3, and incline a little upward in L4-L5. In L1-L3, the transverse processes arise from the junctions of the pedicles and laminae, but in L4-L5, they arise from the pedicles and posterior portions of the vertebral bodies since they are set farther forward. The transverse processes are positioned in front of the articular processes instead of behind them as in the thoracic vertebrae, and are homologous with the ribs .