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Lumbar Radiculopathy

What is a Lumbar Radiculopathy?

A lumbar radiculopathy is pain felt from an irritated spinal nerve. Even though the nerve is pinched in the low back (lumbar spine), most of the pain is often felt in the leg.

This if often confusing to patients who believe the problem must be in the leg itself.

What causes a Lumbar Radiculopathy?

In younger patients, the nerve is often pinched by a lumbar disc herniation. In older patients, the reasons are often more diverse. At times, it is the fact that the disc height has been lost. When this occurs, there is less room for the spinal nerves to leave the spine through an opening called a foramen.

In other patients, the foramen is narrowed because of bone spurring from osteoarthritis [link] of the facet joints. A narrowed lumbar foramen is called “Lumbar Foraminal Stenosis”.

What symptoms does a Lumbar Radiculopathy cause?

While patients may have some low-back, hip and buttock pain with this condition, the pain is often worse in the leg. The pain follows the exact path of the nerve from the vertebral column down into the leg.

Here are some of the typical symptoms:

  1. Pain shooting into the leg from the low back or hip area
  2. Numbness or tingling in the leg
  3. Weakness in the leg

How do Spine Specialists diagnosis a Lumbar Radiculopathy?

The diagnosis of a lumbar radiculopathy depends on a complete history, physical examination, and spinal images.

  1. History

The symptoms reported by the patients are often the first key in the diagnosis. Pain in the low back which travels to the leg is a

classic symptom. Numbness or tingling in the leg and the feeling of weakness can also occur and help confirm the diagnosis.

       2. Physical Examination

Here are some of the common physical examination techniques used:

  1. Mobility of the low back (range of motion)
  2. Palpation (touch and pressure) of the low back
  3. Sensation testing in the legs
  4. Strength testing in the legs
  5. Reflex testing in the legs
  6. Straight Leg Raising test
  7. Gait testing

 

       3. Spine Images

In order to obtain some objective information about the problem, special spine images are often ordered. Here are some of these imaging studies:

a. X-Rays

A plain X-Ray can be useful in diagnosing certain types of lumbar radiculopathy. In older patients the narrowing of a foramen (foraminal stenosis) may be seen if it is due to a bone spur or loss of the height of a disc. However, the spinal nerve or disc itself cannot be seen.

b. CT Scans

A CT scan can show the bone anatomy of the low back in much more detail than plain X-Rays. Bone spurring which causes the foramen to narrow can be seen very clearly. However, the discs, spinal cord and spinal nerves can be difficult to visualize. Also, CT scans involved significant radiation.

c. MRI Scans

An MRI scan is usually the test of choice since it can show the most detail about the softer structures such as discs, spinal cord and spine nerves. Since a lumbar radiculopathy results from an irritated spinal nerve, visualizing this nerve is important. The MRI allows the spine specialist to see the critical structures and be able to evaluate if the spinal cord itself is at risk or involved. The bone anatomy of the low back is not seen as clearly as it is on a CT scan but usually well enough to know if a bone spur is the cause or a contributor.                   

  1. EMG/NCS

Electromyograms (EMG) and Nerve Conduction Studies (NCS) can help verify which nerve is involved in the Radiculopathy. These studies can also tell how severe the nerve compression is and whether the nerve appears to be recovering.

How do Spine Specialists treat a Lumbar Radiculopathy?

Here are some of the Non-Surgical and Surgical treatments available:

  1. Non-Surgical (conservative)

Non-surgical treatments are usually recommended prior to surgery, unless a patient has significant neurological problems related to the nerve compression. The majority of patients respond to conservative care and will not need surgery. Some of the conservative means to treat a lumbar radiculopathy are:

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage Therapists have techniques which can help with the muscle components of symptoms form this condition.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms.

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. Specialized exercises can maintain muscle strength and function. Ultrasound, manual treatments, and electrical stimulation can help with the muscle pain and spasm. Physical therapy can be very useful in the treatment of a lumbar radiculopathy.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. There are also a variety of Non-Surgical Decompression devices on the market which may offer some benefit.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

Non-Steroid Anti-Inflammatory Drugs (NSAIDS) are often used and may be helpful in reducing the inflammation and subsequent swelling of a spinal nerve.

 2. Steroids

Steroids are more potent than non-steroid anti-inflammatory medications and can be very helpful in controlling the pain. They are usually given by mouth. However, they are often more difficult to tolerate due to the side effects.

3. Muscle Relaxants

Muscle relaxants can help with the painful back spasms common in this condition.

4. Pain killers

Pain Killers can also help, but unlike the anti-inflammatory medications do not treat the problem itself, but rather the symptoms of the problem.

5. Antidepressants

Some antidepressant medications can have nerve pain relieving properties.

6. Nerve pain medications

These medications can come from different groups of medications such as antidepressants or anticonvulsants (medications often used for seizures) which have nerve pain relieving properties.

H. Injections

Epidural steroid injections can help with Lumbar Radiculopaties. Here are some options:

  1. Lumbar Interlaminar ESI
  2. Lumbar Transforaminal ESI
  3. Lumbar Nerve Root block
  4. Caudal Epidural Steroid Injection

      2. Surgical Care

Surgery is sometimes required for severe cases of Lumbar Radiculopathy if the non-surgical care has not been found to be effective. In cases of significant leg weakness from the nerve compression, surgery can be offered earlier.

Here are some surgical procedures offered for Lumbar Radiculopathies:

  1. Lumbar Laminotomy and Foraminotomy
  2. Lumbar Laminectomy
  3. Lumbar Endoscopic Foraminotomy
  4. Lumbar Discectomy
  5. Endoscopic Lumbar Discectomy
  6. Lumbar Endoscopic Discectomy
  7. Lumbar Micro Discectomy
  8. Lumbar Fusion