LUMBAR RADICULOPATHY

Background:

Compression of the nerves owing to “wear and tear,” or trauma appears as the most common cause of lumbar radiculopathy. The majority of instances are caused by disc herniation, cysts, and spinal canal constriction. Tumors and infections are two more uncommon reasons. Our doctors specialize in the spine and are trained to diagnose and treat lumbar radiculopathy.

Risk Factors:

Men are somewhat more likely than women to develop lumbar radiculopathy, and the average age at the time of disc surgery is 40. Driving vocations, frequent lifting, twisting motions, heavy industry labor, back injuries, higher height, smoking, overweight, sedentary lifestyle, numerous pregnancies, back pain history, and chronic cough are all risk factors.  This includes bulging discs, spinal stenosis, or injury to the spine. Often a patient may “overdo” a certain strenuous activity, such as gardening or lifting boxes

Area of Pain Distribution

Sciatic pain can occur when an affected spinal nerve root travels directly into the thigh, calf, and sometimes the foot. Sciatica causes pain that goes along the sciatic nerve, down the back of the thigh and calf into the foot. Leg pain becomes more severe than lower back pain. The affected parts of the leg and/or foot are determined by the nerve in the lower back that becomes impacted. Pain in the front of the leg and shin can originate from the compression of upper lumbar nerve roots.

With this condition, the specific areas of the leg and/or foot that are affected depend on which nerve in the low back is affected. Compression of higher lumbar nerve roots such as L2, L3, and L4 can cause radicular pain into the front of the thigh and the shin. This distinction is crucial as it helps in diagnosing the exact source of the pain, allowing for more targeted treatment options. Understanding these nuances between low back pain and radicular pain is vital for effective pain management. By identifying the precise nerve roots involved, healthcare providers can develop a more accurate and personalized treatment plan.

Causes of Lumbar Radiculopathy

This condition can result from a variety of factors that irritate or compress the spinal nerve roots, such as lumbar disc herniation, spinal stenosis, and a host of other conditions.

Overview of the Symptoms of Lumbar Radiculopathy

Lumbar radiculopathy, commonly referred to as sciatica, is a condition that occurs when one or more nerve roots in the lumbar spine become compressed, irritated, or inflamed. These nerve roots exit the spinal column in the lower back and travel down the legs, controlling movement and sensation in the lower body. When a nerve root is compressed, it can result in various symptoms that range in intensity, depending on the severity of the nerve impingement. Below is a detailed exploration of the key symptoms associated with lumbar radiculopathy.

Lower Back Pain

While the hallmark of lumbar radiculopathy is pain radiating down the leg, many individuals also experience lower back pain. The pain may be localized in the lower lumbar region and can range from a dull ache to a sharp, stabbing sensation. This pain is often exacerbated by activities such as bending, lifting, or prolonged sitting.

In some cases, the lower back pain may improve as the radicular symptoms (pain radiating down the leg) worsen, leading some patients to experience more leg pain than back pain. Conversely, others may experience prominent lower back discomfort alongside radiating symptoms.

Radiating Leg Pain (Sciatica)

One of the most recognizable symptoms of lumbar radiculopathy is pain that radiates down one or both legs, commonly known as sciatica. This pain follows the path of the affected nerve and typically extends from the lower back through the buttock and down the back or side of the leg. The pain may be constant or intermittent, and it can range from mild to severe. The pain is often described as:

• Sharp, shooting, or burning: Pain may feel like an electric shock, and it can be triggered by certain movements, such as coughing, sneezing, or sitting.
• Localized or diffuse: Some patients may experience pain localized to the buttock or thigh, while others may feel pain radiating all the way down to the foot.
• Unilateral: Lumbar radiculopathy typically affects one side of the body, though in rare cases, bilateral symptoms (affecting both legs) may occur.

Numbness and Tingling (Paresthesia)

Numbness and tingling, medically known as paresthesia, are common symptoms associated with lumbar radiculopathy. These abnormal sensations often follow the same path as the radiating pain, occurring in the buttocks, thighs, calves, or feet. Patients may describe the sensation as:

• Pins and needles: A prickling or tingling feeling, particularly in the toes or foot.
• Decreased sensation: Some areas of the leg or foot may feel less sensitive to touch, temperature, or other sensations.
• Patchy numbness: The numbness may not affect the entire leg but rather small, isolated areas along the nerve’s pathway.

Muscle Weakness

In more severe cases of lumbar radiculopathy, the compressed nerve can lead to muscle weakness in the affected leg. This weakness occurs because the nerve roots that control muscle movement are impaired, reducing the strength and control of the muscles they innervate. The specific muscles weakened will depend on which nerve root is affected, but common patterns include:

• Weakness in the foot and ankle: Patients may experience difficulty lifting the foot (foot drop), causing them to drag their foot when walking.
• Weakness in the calf or thigh: Some patients may struggle to stand on their toes or rise from a squatting position.
• Difficulty with mobility: Muscle weakness may make it challenging to perform daily activities like climbing stairs, walking long distances, or standing up from a seated position.

Loss of Reflexes

Compression of a lumbar nerve root can also lead to the loss of reflexes in the affected leg. Reflexes, such as the knee-jerk reflex, are typically diminished or absent in individuals with lumbar radiculopathy. Reflex testing is often a key part of the diagnostic process, as the absence of reflexes can help determine which nerve root is compressed.

Bladder and Bowel Dysfunction (Cauda Equina Syndrome)

In rare cases, lumbar radiculopathy can lead to a condition known as cauda equina syndrome, which occurs when the nerve roots at the base of the spine (the cauda equina) are severely compressed. This is a medical emergency and requires immediate attention. Symptoms of cauda equina syndrome include:

• Loss of bladder or bowel control: Patients may experience difficulty urinating, loss of sensation in the bladder, or incontinence.
• Severe weakness in both legs: Bilateral leg weakness may be present.
• Saddle anesthesia: Numbness in the areas that would touch a saddle, including the inner thighs, buttocks, and perineum.

If any of these symptoms occur, immediate medical intervention is crucial to prevent permanent nerve damage.

strong>Worsening Symptoms with Movement or Prolonged Activity

Many patients with lumbar radiculopathy report that their symptoms worsen with specific movements or prolonged activity. For example:

• Sitting for long periods: Sitting places additional pressure on the lumbar spine and may intensify pain and tingling.
• Bending or twisting: Movements that strain the lower back, such as bending forward or twisting, can aggravate the symptoms.
• Lifting heavy objects: Straining the muscles and nerves of the lower back through heavy lifting can cause or exacerbate pain.

Improvement with Rest

In contrast, symptoms of lumbar radiculopathy often improve with rest, particularly lying down or assuming positions that take the pressure off the compressed nerve. This is a hallmark sign of nerve compression, as the nerve becomes less irritated when the spine is not bearing weight or being strained.

Conclusion

Lumbar radiculopathy presents a wide range of symptoms, including lower back pain, radiating leg pain, numbness, tingling, muscle weakness, and, in rare cases, loss of bladder or bowel control. These symptoms can significantly impact a person’s quality of life, particularly if the condition is not treated in its early stages. Fortunately, many cases of lumbar radiculopathy improve with conservative treatments like physical therapy, medications, and lifestyle modifications, though surgery may be required in more severe cases.

Early diagnosis and treatment are key to managing lumbar radiculopathy and preventing complications, such as permanent nerve damage or cauda equina syndrome. Individuals experiencing any of the above symptoms should consult a healthcare professional for proper evaluation and treatment.

Diagnosis of Lumbar Radiculopathy

Compression and/or damage to a spinal nerve root in the low back causes radiculopathy. The following identifies the most common causes of this sort of pain:

• The most common cause stems from a herniated disc with nerve compression.
• Stenosis appears more frequently in seniors (a narrowing of the spine).
• Nerve root damage from diabetes
• Previous spinal surgery scar tissue that causes damage to the nerve root

Understanding the Causes of Radiculopathy

Radiculopathy is often the result of compression, inflammation, and/or injury to a spinal nerve root in the low back. Each cause has its unique impact on the spinal nerve:

• Herniated Disc with Nerve Compression: This is by far the most prevalent cause. When a disc herniates, it can compress nearby nerves, leading to significant pain and discomfort.
• Foraminal Stenosis: This involves the narrowing of the hole through which the spinal nerve exits, often due to bone spurs or arthritis. It’s more common in elderly adults, contributing to a higher incidence of radiculopathy in this population.
• Diabetes: This condition can lead to nerve root injuries by causing damage to the nerves over time. High blood sugar levels associated with diabetes can deteriorate nerve fibers, leading to chronic pain and radiculopathy.
• Nerve Root Injuries: Beyond diabetes, other injuries to the nerve root can result from physical trauma or inflammation.
• Scar Tissue from Previous Spinal Surgery: This can impinge on the nerve root, leading to radiculopathy. Scar tissue may develop post-surgery, causing complications and persistent pain.

By understanding these causes, you can better appreciate the complexities of diagnosing and treating radiculopathy. Each condition, whether due to degenerative changes, systemic diseases like diabetes, or post-surgical complications, highlights the need for a tailored approach to management and care.

Treatment of Lumbar Radiculopathy

Nonsurgical treatment (including physical therapy, medicines, and specific spinal injections, among other things) is suggested for six to eight weeks. Decompressive surgery normally occurs if nonsurgical therapy fails to relieve the pain. For 85 percent to 90 percent of patients, this type of surgery offers relief from leg pain. This form of surgery may begin prior to six weeks of non-surgical treatment for individuals with major leg pain or other symptoms, such as developing muscle weakness. Back surgery for leg pain appears far more reliable than back surgery for low back pain. The intensity of leg pain and/or the presence of muscular weakness normally determines the need for surgery.  Back surgery does not enter into the picture if the nerve compression cannot get verified by an MRI or CT scan.

When you first read that lumbar radiculopathy is the term that spine specialists use for sciatica, it may sound bizarre and unusual. It’s a common ailment and one of the main reasons patients seek a spine surgeon. Up to 5% of Americans may suffer from lumbar radiculopathy. While most cases of this nerve problem cure themselves, the pain might become persistent in some cases. Our specialists are experts in the diagnosis and treatment of lumbar radiculopathy.  They keep on the cutting edge of neurosurgery by using the most up-to-date treatments. For example, minimally invasive techniques reduce recovery time when surgery occurs as the only option. However, keep in mind that early treatment of back pain helps to prevent surgery.

7 Nonsurgical Procedures that Provide Comfort Without Surgery

Physical therapy

Conservative back pain treatment recommends exercise under the guidance of a physical therapist. A personal back pain program can help you strengthen the muscles that support your spine while also improving your ability to move.

Drug therapy

Analgesics, anti-inflammatories, and muscle relaxants, as well as over-the-counter and prescription medications, form a drug treatment strategy. As such, drug therapy is frequently used to ease the pain.

Injection-based treatments

When the position of nerve compression becomes known, corticosteroid injections, nerve blocks, nerve ablations, and other procedures may help reduce or stop the pain.

Activity modifications

Activity and task analysis may help to reduce the burden of lumbar radiculopathy. Therefore, finding alternatives begins with knowing which motions or jobs cause your pain. For instance, using a cart to haul groceries may eliminate a cause of nerve pain.

Diet changes

Your diet may contribute to a healthy body.  Thus, eating incorrectly with processed meals high in refined sugar and trans fats is not good. However, eating correctly will help lose weight and relieve pressure on the spinal column.

Alternative medicine

Alternative therapies such as acupuncture and chiropractic care may reduce the effects of lumbar radiculopathy, however, they are not beneficial for everyone. In addition, biofeedback and electrical nerve stimulation are two more options that some people find helpful.

Meditation

Chronic pain causes both physical and mental stress, which can lead to irritability, rage, and despair. Also, yoga, tai chi, and regulated breathing exercises provide meditative treatments that might help you manage back pain.

Understanding the Risks and Benefits of Decompressive Surgery for Lumbar Radiculopathy

Decompressive surgery, such as laminectomy and discectomy, is a common treatment for lumbar radiculopathy, especially when nonsurgical methods fail. Let’s delve into both the risks and benefits associated with this procedure.

Benefits of Decompressive Surgery

• High Success Rate: Approximately 85% to 90% of patients experience significant relief from radicular pain (leg pain) post-surgery.
• Rapid Pain Alleviation: For those with severe symptoms, including progressive muscle weakness, decompressive surgery can provide quicker relief than prolonged nonsurgical treatments.
• Improved Mobility: Patients often regain improved mobility and functionality, enhancing their overall quality of life.

Risks of Decompressive Surgery

• Surgical Risks: As with any surgery, there are inherent risks such as infection, bleeding, and adverse reactions to anesthesia.
• Potential Nerve Damage: Although rare, nerve damage can occur, potentially leading to long-term complications.
• Limited Efficacy for Low Back Pain: This surgical option is significantly more effective for leg pain compared to low back pain. Patients with predominant low back pain may not see the same level of benefit.

Factors Influencing Surgery Decision

• Severity of Symptoms: Surgery is often considered when leg pain is severe or when muscle weakness is progressing.
• Imaging Confirmation: It’s crucial to confirm nerve compression via MRI or CT-myelogram before proceeding. Without definitive evidence, the success rate of the surgery drops considerably.

In summary, while decompressive surgery offers substantial relief for many patients suffering from lumbar radiculopathy, it’s essential to weigh the benefits against the potential risks. Proper diagnosis and a tailored approach remain key to achieving the best outcomes.

Surgical Treatments

If nonsurgical treatment is ineffective, decompressive surgery might be necessary. This includes:

• Laminectomy: Removing part of the vertebra to relieve pressure on the nerve.
• Discectomy/Microdiscectomy: Removing the herniated portion of a disc to relieve nerve compression.

These procedures typically provide significant relief of radicular pain (leg pain) for 85% to 90% of patients. For those experiencing severe leg pain or other serious symptoms such as progressive muscle weakness, surgery may be recommended even before completing six weeks of nonsurgical treatment. It’s important to note that surgery for radicular pain is generally more reliable than surgery for low back pain.

By understanding both nonsurgical and surgical options, patients can make informed decisions about their treatment paths.

About Southwest Scoliosis Institute

From the first time you walk into our offices in either Dallas, Plano, or Frisco, Texas you will feel at ease. You will talk to one of our expert doctors.  Our doctors will listen and understand your problem and perform a detailed exam.  Based on your phone call, you may be asked to undergo a diagnostic study before your appointment (such as X-rays or MRIs). Because your spine specialist can learn lots of information from your symptoms and your physical assessment during your appointment, these tests will enable the doctor to have an in-depth knowledge of your condition.

The doctor will review your scans and other tests with you, in detail, and provide a diagnosis. After you become well-informed, you and your doctor will plan the right treatment. Finally, if your Spine Specialist feels that surgery is not the right decision in your case, he’ll tell you that, too, and offer a non-surgical remedy as to the first course of treatment.

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National Institute of Health: Lumbar Radiculopathy