Lumbar Radiculopathy
Close to 80% of the population in the United States suffer at one point or another from back pain. Associated leg pain occurs less frequently. Patients complain that pain is debilitating and limiting their ability to engage in their normal daily activities. Leg and back pain can be caused by a variety of reasons, not all of which originate from your spine.
Lumbar radiculopathy is pain in the lower extremities, inneravated by a specific lumbar nerve. Compression of the roots of the spinal nerves can be one of the causes of the pain in the lumbar region of the spine. A proper diagnosis begins be obtaining a detailed medical history from the patient and a comprehensive physical examination by the physician.
Medical History
Providing a detailed medical history to your physician will help him to better understand the problem and give you a proper diagnosis. It is important to be specific in answering your physician’s questions that are related to the onset of pain. It is also helpful to keep a records of your medical history, your medical problems, the medications you are taking and have taken in the past, and past surgeries.
In regards to your leg and back pain, it is helpful to keep a journal of your daily activities, noting when the pain begins, what aggravates (worsens) the pain, and what helps to alleviate or reduce your pain symptoms. Your doctor will want to know if your back pain is more bothersome than your leg pain or vice versa. Let your doctor know if you are experiencing numbness or weakness in your legs or have any difficulty walking. Remember, understanding the cause of your problem is based on the information you provide.
Radicular pain is described as:
- Sharp or burning pain that shoots down the leg (sciatica) which may or may not begin in the low back
- Leg pain caused by compressed nerve roots
Anatomy of the spine
The spine is comprised of 33 vertebrae (bones stacked on top of each other in a "building-block" fashion). The spine has 4 distinct regions: Cervical, Thoracic, Lumbar, and Sacral.
Discs, cushion-like tissues separate most vertebrae and act as the spine's shock absorbing system. The disc has a tough outer ring of fibers called the Annulus Fibrosus and a soft gel-like center called the Nucleus Pulposus.
The head is supported by 7 flexible cervical (neck) vertebrae. There are 12 thoracic (chest) vertebrae, which attach to ribs. The 5 lumbar vertebrae are large and carry the majority of the body weight. The sacral region helps distribute the body weight to the pelvis and hips.
The spinal cord is housed within the protective spinal column. Spinal nerves come from the spinal cord and travel through a tunnel or foramen. The nerves provide sensory (allowing you to touch and feel) and motor information (allowing the muscles to function) to the entire body.
Lumbar Radiculopathy: Diagnosis
Physical Examination
- Your doctor will ask you to stand, walk or lie down on the examing table
- In the lying down position, your physician will raise each of your legs to demonstrate flexibility and strength in your low back and legs
This table is a summary for the examination performed and possible findings:
| Nerve Root Involved | Possible Exam Findings with Nerve Root Compression |
| L2 | Decreased hip flexor strength |
| L3 | Decreased patellar reflex Sensation loss of the anterior thigh Weakness in quadriceps muscle Pain in the area of the anterior thigh |
| L4 | Sensory loss of the anterior lateral or medial foot Possible decreased patellar tendon reflex Weakness of the quadriceps Pain in the area of the anterior leg |
| L5 | Sensory loss in the dorsum of the foot and great toe Weakness of the anterior tibialis, great toe (extensor hallicus longus), and hip abductors Pain down the side of the leg |
| S1 | Decreased Achilles reflex Sensory loss of the lateral foot and the small toe Weakness of the gastrocnemius, gluteus maximus, plantar flexor, and great toe Pain down the back of the leg into the bottom or side of the foot |
Diagnostic Studies
To confirm your diagnosis the following diagnostic studies may be ordered by your physician:
- X-ray: is used to show the bony anatomy of the spine. In an X-Ray, the physician is looking for the alignment and integrity of the bony structures. Integrity in this sense means no degeneration in the bone structures.
- MRI (Magnetic Resonance Imaging): An MRI produces images of the soft tissues of the spine. Using an MRI, the physician looks at the soft tissue structures such as the discs, ligaments, spinal cord, and spinal nerves. The physician looks at the integrity of the discs themselves for degeneration (dark in color because of loss of hydration), bulging or herniation (where the disc contents protrude into the spinal canal and compress the nerves or spinal cord). If there is a herniation present, the MRI helps the physician determine if the nerves are being pinched or smashed by the herniated disc.
Treatment
Low back pain with lumbar radiculopathy is often treated conservatively. This may include a combination of rest, medication, and a home exercise or structured physical therapy program.
Surgery may be recommended if symptoms persist after conservative treatment. These symptoms may include severe pain, increasing numbness, or weakness of the legs. The decision for surgical intervention is often made when conservative treatment has failed and the symptoms are interfering with your daily function causing lifestyle changes such as an inability to work or participate in the activities you enjoy.
