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Pain and Spine Medicine

Unusual Presentation of L5/S1 Lumbar Radiculopathy in Healthy Young Adult :A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Co-Author(s)

  • Quynh Giao Pham, MD

    Staff Physiatrist
    Department of Physical Medicine and Rehab (117) West Los Angeles VA Healthcare
    Los Angeles, California

    • Primary Author(s)

  • Magda Wojtara, MS

    Medical Student
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Los Angeles, California

  • Julieta Serobyan, BS

    Medical Student
    University of California Los Angeles David Geffen School of Medicine
    Los Angeles, California

    • Co-Author(s)

  • Theodora L. Yellowman (she/her/hers)

    Medical student
    David Geffen School of Medicine
    Mesa, Arizona

  • Lauren Weber, BS

    Medical Student
    David Geffen School of Medicine
    Los Angeles, California

    • Poster Presenter(s)

  • Jennifer Tram, MD

    Medical resident
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Los Angeles, California

Disclosure(s):
Magda Wojtara, MS: No financial relationships to disclose
Julieta Serobyan, Other: No financial relationships to disclose
Theodora L. Yellowman: No financial relationships to disclose
Lauren Weber, BS: No financial relationships to disclose
Case Diagnosis: A 20-year-old female with progressive right ankle dorsiflexion weakness in the absence of pain

Case Description or Program Description:: A 20-year-old female presented with an inability to dorsiflex her right ankle or extend her toes, along with occasional numbness on the dorsum and plantar area of the foot. There was no history of trauma or inciting event, and she denied pain, low back discomfort, or bowel/bladder issues. A prior lumbar MRI for low back pain revealed a mild L5/S1 disc bulge. Initial examination showed normal ankle range of motion, mild right dorsiflexor weakness, and bilateral hyperreflexia. Brain, cervical, and thoracic spine MRIs were normal, and the patient was lost to follow-up.
Two years later, she presented with progressive weakness in right ankle dorsiflexion, plantar flexion, eversion, inversion, and knee flexion. No muscle atrophy was noted in the affected leg, sensory exam was normal, and bilateral reflexes were hyperactive and symmetrical in both upper and lower extremities.

Setting: A university-based medical center

Assessment/Results: Nerve conduction studies showed normal right peroneal motor, superficial peroneal, and sural nerves. Electromyography revealed active and chronic denervations in right L5/S1 myotomes, consistent with active chronic radiculopathy

Discussion (relevance): Lumbar radiculopathy typically presents radicular pain and low back discomfort. This rare case of isolated ankle weakness without radicular pain or low back symptoms initially misled clinicians toward upper motor neuron conditions.

Conclusions: Lumbar radiculopathy can be present without leg pain, low back pain, or typical radicular symptoms. It should be considered in the differential diagnosis of leg weakness, and electrodiagnostic studies can aid in diagnosis.