Lumbar Radiculopathy

Description

Lumbar radiculopathy is irritation of a nerve root in the lower back. It causes pain in the lumbar region that radiates down one or both legs.

Causes

Causes of lumbar radiculopathy can include herniated disks, degenerative disk disease, bone spurs, tumors, arthritis, spinal stenosis, compression fractures, spondylolisthesis, scoliosis, and diabetes.

Risk factors include increasing age, excessive weight, poor posture, strenuous lifting with poor technique, repetitive movements, and family history of degenerative spine disease.

Symptoms

Lumbar radiculopathy is characterized by pain that radiates from the lower back down the back of a leg to the calf or foot. The pain is deep and constant and can be associated with numbness, tingling, weakness, and diminished reflexes. When the pain is secondary to compression of the lower spinal nerve roots, L5 and S1, it is termed sciatica. Irritation of higher nerve roots such as at L2, L3 or L4 levels causes pain in the front of the thigh and shin.

Diagnosis

The initial step in diagnosing lumbar radiculopathy involves a thorough history and physical exam. The physical exam is likely to include sensory and muscle testing, a deep tendon reflexes assessment, and other tests that try to reproduce and confirm the diagnosis. With nerve compression, sensory loss occurs in anatomical patterns referred to as dermatomal distributions. The favored diagnostic imaging modality is an MRI without contrast, which can delineate nerve root compression. A CT myelogram is another useful imaging modality. If the imaging studies do not correlate well with the physical exam finding, electrodiagnostic studies can help establish the diagnosis. Diagnostic nerve blocks can also help determine if the pain is from radiculopathy.

Management

Managing lumbar radiculopathy is usually non-surgical. Non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen, along with ice and heat application are the initial steps in managing symptoms. Physical therapy is an important modality in alleviating pain and in aiding recovery. Depending on the cause of the lumbar radiculopathy, steroid injections can help as well. Surgery will most likely be needed if the nerve compression is severe and results in unremitting pain and motor weakness.