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A 37-year-old man bent down to pick up a heavy weight and felt a severe pain in his lower back. The pain radiates down the back of his left leg as far as the ankle. There is no significant past medical history. He walks into the department.
Physical examination indicates a man, obviously in pain, who has very reduced back movements, especially flexion. Examination of power in the proximal muscles of the leg is difficult because of pain. Ankle dorsiflexion is strong bilaterally, but left ankle plantar flexion and big toe flexion appear weak. He has altered sensation over the lateral side of the left foot. You diagnose sciatica due to a prolapsed intervertebral disc.
The neurological signs indicate a lesion of which nerve root?
When you examine the tendon reflexes in the left leg, what do you expect to find?
Further assessment of this patient reveals no significant past medical history. He has no urinary symptoms. Sacral sensation is intact and he has a normal rectal examination.
What investigations are required for this patient in the ED?
How should you treat this patient?