What is Lumbar Radiculopathy?

Lumbar radiculopathy is a condition where the spinal nerves around the lumbar region (lower back) are compressed or pinched which leads to pain, numbness or weakness, and tingling sensation

Lumbar Radiculopathy Symptoms

Lumbar radiculopathy is the proper term for a condition commonly referred to as sciatica.  Lumbar radiculopathy specifically refers to a condition where there is compression or stenosis involving a nerve in the lumbar spine (lower back) which causes pain to radiate down the leg.  This compression can be caused by a variety of causes including a herniated disc, degenerative disc disease, spondylolisthesis, a synovial facet cyst, or scoliosis, in addition to other less common causes.  It is common to also have back pain along with leg pain, but pain in the buttock and leg are the hallmark of lumbar radiculopathy symptoms.

The precise distribution of pain depends on which nerve root is involved.  The L4, L5, and S1 are the most common nerve roots affected that cause lumbar radiculopathy symptoms.  L4 nerve symptoms are felt in the side of the hip, to the front of the thigh across the front of the knee, down the front of the shin bone to the instep of the foot.  L5 nerve symptoms are felt in the buttock, down the back of the thigh, to the outer aspect of the lower leg, into the top of the foot. S1 nerve symptoms are felt in the buttock, down the back of the thigh, into the back of the calf, and into the outside part of the foot.  Numbness, tingling, and weakness can also accompany the pain symptoms of lumbar radiculopathy.

Lumbar Radiculopathy Assessment and Diagnosis

The initial lumbar radiculopathy assessment is best done by a primary care doctor, a non-operative spine physician (physiatrist or pain management trained anesthesiologist), or a spine surgeon.  A careful and detailed patient history and physical exam are often all that is necessary in the initial diagnosis of lumbar radiculopathy. X-rays are also often obtained of the lumbar spine (lower back) at the initial visit, and are especially useful to assess the spine when done in an upright or standing position.  If the symptoms of lumbar radiculopathy have been present for more than 6 weeks, or are also associated with significant or worsening weakness, then the next step in lumbar radiculopathy assessment is obtaining an MRI of the lumbar spine for a detailed assessment of the nerves and to plan for more invasive treatment.

Lumbar Radiculopathy Treatment

 

Non Surgical Treatment

Fortunately, most episodes of sciatica or lumbar radiculopathy resolve with conservative measures and time over 6-12 weeks.  Initial lumbar radiculopathy treatment in the first 0-3 weeks involves the use of anti-inflammatory medications (NSAIDS), continuing with regular low-impact aerobic exercise (walking, elliptical machine, stationary bike, swimming, etc.), and doing some self-directed stretches and exercises for sciatica.  If symptoms are persistent, the next step is beginning formal lumbar radiculopathy physical therapy which can involve stretches, nerve gliding exercises, core and pelvic strengthening, and modalities such as ultrasound, heat, ice, electrical stimulation, and dry needling. Lumbar radiculopathy physical therapy can be very helpful in relieving the pain symptoms down the leg.

If symptoms have been persistent for more than 6 weeks and other non-invasive conservative measures have failed to provide relief, an MRI of the lumbar spine is usually performed next to guide more invasive treatment.  This can involve referral to a non-surgical spine specialist to perform targeted nerve root injections (a specialized type of an epidural injection) to decrease the inflammation around the nerves causing the lumbar radiculopathy pain.

Surgical Treatment

If conservative measures have failed and leg pain symptoms are persistent, or if there is significant weakness or other neurologic deficit present, then surgical treatment is considered.  The precise surgical treatment depends on exactly what is causing the nerve compression, and if there is a spinal deformity or instability present. Surgical treatments can include a microdiscectomy, lumbar decompression, or a spinal fusion.  These often can be done in a minimally-invasive fashion. The appropriate surgical treatment can be different for each patient and is decided upon after a thorough discussion between the patient and surgeon.

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