Lumbar Radiculopathy (Sciatica)
This condition is an irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs, and feet, an injury in the lumbar spine can cause symptoms in these areas. Sciatica may result from a variety of problems with the bones and tissues of the lumbar spinal column.
Lumbar radiculopathy is a disorder that is characterized by an irritation of the spinal nerve roots, which run from the lower back down each leg. Lumbar radiculopathy can be caused by many different factors, including a herniated or ruptured disc, bone spur, strenuous activity, an injury to the spine or osteoarthritis. Patients considered at the highest risk are older individuals and younger people who play contact sports or perform manual labor.
Lumbar radiculopathy is often referred to as sciatica since it commonly involves an inflammation of the sciatic nerve. The sciatic nerve is the longest nerve in the body, stretching from the spinal cord to the end of each leg. The condition usually develops gradually, as the nerve is compressed over time.
Causes of Lumbar Radiculopathy
Lumbar radiculopathy occurs when the spinal nerves have become irritated or compressed. Nerve compression may be caused by a variety of factors, including:
- Herniated or ruptured spinal discs
- Bone spurs, which occur when extra bone forms around a weakened herniated disc
- Degenerative disc disease, often resulting from the aging process
- Congenital defects
- Stress caused by repetitive or strenuous activities
- Traumatic injury or event, such as a sports injury or car accident
- Progressive conditions such as rheumatoid arthritis or osteoarthritis
Symptoms of Lumbar Radiculopathy
Lumbar radiculopathy usually causes pain that radiates down the leg to the calf or foot. Abrupt movements may cause this sciatic pain to worsen. Other common symptoms of the condition include:
- Feelings of numbness throughout the legs
- Weakness in the legs
- Tingling or burning sensation in the legs
- Loss of reflexes
- Discomfort with sudden movements, such as standing up after a long period of sitting
Diagnosis of Lumbar Radiculopathy
To diagnose lumbar radiculopathy, a medical history is taken and a physical examination performed. During the medical history portion, the doctor typically asks questions about the type and location of symptoms, as well as how long they have been present. The patient's muscle strength and reflexes will be tested for any abnormalities during the physical examination.
Imaging tests are usually conducted to obtain a clear picture of the lumbar region. X-rays are often conducted first, as they can be helpful in identifying the presence of trauma. MRI tests may be performed to evaluate the extent of the lumbar radiculopathy. For some patients, a CT myelogram may be used in place of an MRI. CT myelograms use X-rays and special dyes known as contrast material, to take pictures of the bones and the spinal canal. CT myelograms are commonly used for patients with pre-existing health problems such as diabetes, severe allergies or kidney disease as well as those with a pacemaker.
Treatment of Lumbar Radiculopathy
Conservative measures are usually the first options considered for treating lumbar radiculopathy. Physical therapy and exercises can help stabilize the spine, strengthen the muscles in the area and maximize flexibility to take some pressure off the injured nerve roots. Medications, such as oral corticosteroids and non-steroidal anti-inflammatories, may also help by reducing pain and swelling. Epidural steroid injections are sometimes used to decrease swelling too, allowing for healing to take place and blocking pain signals.
However, if these treatments cannot provide the patient with relief or symptoms are worsening, surgery will often be required. There are several types of procedures performed to address lumbar radiculopathy. Extreme interbody fusion, or XLIF, is a minimally invasive spinal fusion procedure that is performed through the side of the body to treat spinal disorders and reduce long-term leg pain.
Lumbar laminectomy is a procedure that is designed to relieve pressure on the nerves branching off from the spinal cord by widening the spinal canal. During the procedure, a small section of bone that covers the back of the spinal cord, called the lamina, is removed to create space for the nerves. Another surgical option is lumbar spinal fusion, which involves the fusing of two or more vertebral segments of the spine together. This procedure can relieve pain, numbness, tingling and weakness and restore nerve function.