Importance and specificity of clinical features in foraminal disc herniations in the choice of imaging in order to guide radical treatment

Clinical features about lumbar radicular pain due to foraminal herniationsare different from those resulting from endocanalar herniations.A very demonstrative example about a L2 nerve compressed by aL2L3 level latero foraminal herniation clearly shows the diagnosticaldifficulties encountered, commanding a very specific imagingapproach in order to obtain a precise topographical diagnosis, andlead to the radical therapeutic gesture.The authors review literature data concerning radiculalgiaes causedby lateral herniations. After an anatomic survey, important imagingfeatures and various surgical approaches are studied.A review of cases followed in our department demonstrates thepeculiar symptomatology concerning lumbar radiculalgiaes due toforaminal herniations (sudden start, severe pain resisting to medications,frequent motricity and sensorial deficits, predominance of thehigher lumbar levels), differing from usual endocanalar herniationsfeatures.Thus, it is essential to recognize this clinical context, in order torapidly evoke the diagnosis leading to the best imaging choice, andto establish the aetiological and topographical diagnosis - essentialcondition toward a precise and efficient therapeutical gesture.