level-diagnosis of lumbar disc herniation

little information is at hand on the diagnostic values of the clinical symptoms and signs in the level diagnosis of patients with lower lumbar disc herniation.  we examined one hundred and thirty nine consecutive candidates for lower lumbar discectomy.  monoradicular pain with signs attributed to the fifth lumbar and first sacral root dysfunctions were evaluated independently in each patient.  intra-operatively, all patients were assessed by a single neurosurgeon for the level of disc herniation.  we reached the conclusion that the diagnostic value of clinical features of the herniated fifth lumbar disc is higher than that of the fourth lumbar disc herniation.  the value of clinical presentation in the level diagnosis of lower lumbar disc herniation is highly specific, but rather insensitive.