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Lumbar Radiculopathy

Post-Irradiation Lumbosacral Radiculopathy

Lumbar radiculopathy is a condition, characterized by pain in the lower back region due to nerve compression. Individuals suffer from pain along with numbness in the buttocks and legs.


Presentation

Lumbar radiculopathy causes great discomfort and pain which is often located in the lower leg region compared to the back. Affected individuals suffer from sharp pain that radiates down to the foot, which may aggravate while coughing or sneezing. Many a times, there is associated abdominal pressure when the pain turns severe. This is accompanied by numbness and tingling sensation in the affected leg. Changes in sensation can occur along with loss of reflexes. Prolonged duration of sitting or standing is not possible for such individuals and they may have to frequently change their position in order to avoid pain [7].

Soft Tissue Mass
  • We report a patient who presented with left lumbar radiculopathy, and a peripherally-enhancing dumbbell shaped soft tissue mass involving both the intraspinal and extraspinal compartments on MRI.[ncbi.nlm.nih.gov]
Thrombosis
  • KEYWORDS: postpartum; radiculopathy; thromboembolism; thrombosis; vena cava[ncbi.nlm.nih.gov]
  • We report a case of an adolescent male who presented with lumbar radiculopathy attributable to thrombosed lumbar epidural varix as a result of inferior vena cava thrombosis emanating from factor V Leiden mutation.[ncbi.nlm.nih.gov]
Blurred Vision
  • Side effects consisted of sedation/drowsiness (46%), gastrointestinal upset (23%), headache (19%), blurred vision (15%), weakness/fatigue (11%), and dyscoordination (11%).[ncbi.nlm.nih.gov]
Leg Pain
  • Success at follow-up was 17.5 for visual analogue scale (VAS) leg pain, 22.5 for VAS back pain and 20 for Oswestry Disability Index (ODI).[ncbi.nlm.nih.gov]
  • Secondary: European quality of life measure, visual analogue scale scores for low back pain and for leg pain. RESULTS: Power calculations required the inclusion of 41 patients per group.[ncbi.nlm.nih.gov]
  • It can be challenging to differentiate between orthopedic, neurologic, and vascular causes of leg pain, such as peripheral artery disease (PAD), especially aortoiliac PAD, which can present with hip, buttock, and thigh pain.[ncbi.nlm.nih.gov]
  • This type of surgery typically provides relief of radicular pain/leg pain for 85% to 90% of patients.[spine-health.com]
Hip Pain
  • It is often diagnosed by history and symptoms, which include pain, burning, tingling or numbness that radiate from the lower back and buttock around the back of the thigh to cause low back pain, buttock pain, hip pain, or, most commonly, hip pain.[painmanagement.weillcornell.org]
  • ) Pain down the side of the leg S1 Decreased Achilles reflex (heel) Sensory loss of the lateral (side) foot and the small toe Weakness of the gastrocnemius (calf muscle), gluteus maximus (buttock muscle), plantar flexor (enables you to point your foot[spineuniverse.com]
  • It can cause hip pain and sciatica , or shooting pain in your leg. Incontinence, sexual dysfunction, or paralysis can also occur in severe cases. Learn more: 6 stretches for sciatica » Symptoms vary depending on which type of radiculopathy you have.[healthline.com]
Restless Legs Syndrome
  • BACKGROUND: To investigate the frequency of restless leg syndrome (RLS), sleep quality impairment, depression, fatigue, and sleep behavior disorder and to determine the effects of surgery on these parameters in radiculopathy patients resistant to conservative[ncbi.nlm.nih.gov]
Neurogenic Claudication
  • CLINICAL PRESENTATION: The patient presented with typical symptoms of lumbar radiculopathy and neurogenic claudication. There was no evidence of peripheral gout.[ncbi.nlm.nih.gov]
Excitement
  • Both conventional spin-echo sequences and 3D coronal FFE with selective water excitation (ProSet imaging) were acquired.[ncbi.nlm.nih.gov]

Workup

A preliminary physical and neurological examination is carried out. Physical examination would include determining the range of motion, through tests such as straight leg and cross straight leg test. The test would also provide sufficient information about the nature of symptoms. The gait and balance of the individual would also be analyzed. In addition, imaging studies such as CT scan and MRI would be done to analyze the root cause of the condition [8].

X-rays of the lower back region would be required in order to determine injury or infections in the spinal region. Electromyography is also required for measuring the electrical activity in the muscles and is useful for excluding other causes of sensory and motor disturbances [9].

Schmorl's Nodes
  • This case highlights recent reports emphasizing the clinical pain syndromes possibly associated with Schmorl's nodes.[ncbi.nlm.nih.gov]
Neurophysiologic Abnormalities
  • Neurophysiologic abnormalities had improved on reassessment. Clinical improvement was more significant for those patients with initially abnormal electromyographic results.[ncbi.nlm.nih.gov]

Treatment

Various methods are adopted for treating lumbar radiculopathy depending on the underlying etiology. The following methods would be employed:

  • Medications: Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and opoids are given for effective management of symptoms of pain and tingling sensations. When these do not work or the pain is severe then oral steroids or steroids injection can be given in the lumbar region to reduce pain and swelling.
  • Physical therapy: Exercises are advised to improve the posture and gait. Muscle strengthening exercises are also taught.
  • Transcutaneous electrical nerve stimulation: This forms an important part of treatment regime. Mild intensity electrical currents are given to the affected area in order to reduce the pain and other associated symptoms [10].
  • Surgery: This is usually the last resort and it is done when symptoms do not improve within 4 to 6 weeks of treatment. In this procedure, surgery is conducted to relieve the compressed nerve.

Prognosis

The prognosis of the condition is favorable with recovery occurring within few weeks to months after initiation of treatment. However, the underlying etiology in the causation of lumbar radiculopathy also needs to be considered. Individuals with herniated discs can do well without surgery; and there are significant chances of recurrence of radiculopathy even with treatment. With proper exercise and appropriate body weight, individuals can lead a quality life [6].

Etiology

Several factors such as underlying diseases and or structural abnormalities can cause nerve compression in the spinal region. Herniated disc, physical trauma, injury, mechanical stretching or bone spur can also lead to lumbar radiculopathy. Damage to the discs can occur due to strenuous activity, injury or congenital defect in the spinal region. This causes the cushioning material contained in the disc to leak which in turn exerts pressure on the nerve root, compressing it. Such a type of phenomenon causes pain, and tingling sensation in the affected area [2].

Lumbar radiculopathy can also stem from infections or tumor. In such conditions, the space in the spinal canal is significantly reduced, which in turn exerts pressure on the nerves. Degeneration, which is a common phenomenon of ageing, is also a contributory factor for lumbar radiculopathy.

Epidemiology

About 80% of individuals across the globe fall prey to low back pain. It is one of the main reasons why quality of life is greatly affected. In US, about 3 to 5% are affected by lumbar radiculopathy; with men and women being affected in equal number. However, men aged 40 years and above and women in the age group of 50 to 60 are affected the most. Such a type of trend speaks of the relationship between advancing age and incidence of lumbar radiculopathy [3].

Sex distribution
Age distribution

Pathophysiology

Anatomically, the spine comprises of 33 vertebrae with 4 regions, namely cervical, lumbar, thoracic and sacrum. These vertebrae are separated by discs which are cushioning materials that provide support to the spine by absorbing shocks. These discs contain a tough ring in the outer layer, known as annulus fibrosus and an inner gel-like center which is known as nucleus pulposus [4].

Factors or conditions that cause damage to the discs, can favor development of lumbar radiculopathy. Development of bone spurs, which occurs due to weakening of discs can also lead to narrowing of the space in between vertebrae gradually leading to nerve compression [5].

Prevention

It is not always possible to prevent all the causes of lumbar radiculopathy. Some are inevitable, while some can be prevented by taking necessary precautions. Maintaining good posture and an ideal body weight can prevent the spine and lumbar region from undue pressure. Individuals are also advised to follow the correct posture while lifting heavy objects from ground level. For example, while lifting heavy objects or picking something from floor, it is necessary to bend the knees and not the back. Such a practice would not strain the spine and prevent it from trauma or injuries.

Summary

Due to compression of a spinal nerve, the neighboring muscles, tendons, bones and tissues are gravely affected. Lumbar describes the lower back region and radiculopathy refers to the nerve in the spine region compressed and/or inflamed. Therefore, lumbar radiculopathy indicates the condition that causes pain in the lower back region and leg due to compression of nerves in the spine. Individuals in the age group of 30 – 50 years are more likely to get affected [1].

Patient Information

Definition: Lumbar radiculopathy is characterized by pain in the leg and lower back region due to compression of a nerve in the spine. Men and women are affected in equal numbers and advancing age is one of the major factors for onset of the condition.

Cause: Several factors such as herniated disc, bone spurs, physical injury or trauma to the spine, structural abnormalities, degeneration or disease conditions can cause the nerve root to get compressed, giving rise to lumbar radiculopathy.

Symptoms: Affected individuals suffer from pain in the lower back, which then radiates down the legs accompanied by feeling of numbness and tingling sensation. There is loss of sensation and reflexes in the affected area.

Diagnosis: Physical examination followed by a neurological examination is done in the preliminary level. The gait and balance of the individual is determined using various tests. Imaging studies are indicated for analyzing any injury or development of tumor in the spinal region.

Treatment: Non-surgical treatment methods include medications both steroidal and non steroidal and physical therapy for effective management of symptoms. Surgery is usually the last resort and employed when other methods are not effective in reducing pain and discomfort.

References

Article

  1. Bono CM. Low-back pain in athletes. J Bone Joint Surg Am. Feb 2004;86-A(2):382-96.
  2. Ljunggren AE. Natural history and clinical role of the herniated disc. In: The lumbar spine, 2nd ed, Wiesel SW, Weinstein JN, Herkowitz H, et al. (Eds), WB Saunders, Philadelphia 1996. Vol vol 1, p.473.
  3. Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin. May 2007;25(2):387-405.
  4. Hay MC. Anatomy of the lumbar spine. Med J Aust 1976; 1:874.
  5. Brown HA, Pont ME. Disease of lumbar discs. Ten years of surgical treatment. J Neurosurg 1963; 20:410.
  6. Levin KH. Radiculopathy. In: Comprehensive Clinical Neurophysiology, Levin KH, Lüders HO (Eds), WB Saunders, New York 2000. p.627.
  7. Bogduk N. The lumbar disc and low back pain. Neurosurg Clin N Am 1991; 2:791.
  8. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992; 268:760.
  9. Nardin RA, Patel MR, Gudas TF, et al. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve 1999; 22:151.
  10. Malanga GA, Nadler SF. Nonoperative treatment of low back pain. Mayo Clin Proc. Nov 1999;74(11):1135-48.

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Last updated: 2018-06-22 02:52