Lower back pain is one of the most common musculoskeletal complaints and brings many people to the doctor. The causes for lower back pain vary significantly, and it affects up to 90 percent of people at some time in their lives. Lumbar radiculopathy is a specific type of lower back pain that can be temporary or indicate other medical issues.
The spine consists of 33 bones called vertebrae. It has a canal that runs through the center for the spinal cord, and a nerve root located at each vertebra. These nerve roots allow nerves to travel out of the spinal canal and connect to the body. Lumbar radioculopathy is the condition that occurs when the nerve roots in the lumbar spine — five vertebrae located between the rib cage and the pelvis — are pinched or damaged. Lumbar radiculopathy is also called sciatica because it often affects the nerve roots that make up the sciatic nerve.
The primary symptom of lumbar radiculopathy is a burning, sharp, or electric pain that radiates down the legs. The location and type of pain usually relate to the area of nerve compression or injury. Other symptoms include tingling, numbness, and weakness in the affected leg or foot. Symptoms may occur after an injury, but they can also develop for seemingly no reason.
The underlying cause of lumbar radiculopathy is nerve compression, but many things can cause it. Most often, it is due to a traumatic injury, bone spur, herniated disc, or congenital defect. These issues damage the disc, which then compresses the nerve root. Symptoms typically start in midlife and are often secondary to aging. For men, the symptoms are likely to begin in their 40s; for women, their 50s and 60s.
A diagnosis of lumbar radiculpathy requires a physical exam. Clinicians perform various maneuvers to diagnose the condition, including the straight leg or Lasègue test, which places tension on the sciatic nerve. The clinician passively raises the patient's leg into the air to a 30 to 60-degree angle to attempt to reproduce pain. If the patient feels pain, the test is positive and suggests lumbar radiculopathy.
Lumbar radiculopathy pain can indicate serious conditions the physician should rule out during the exam. Accompanying symptoms that could indicate a significant health problem include chest pain, fever, unexplained weight loss, cancer, night sweats, and bowel or bladder dysfunction. Another red flag is if the symptoms first appear in people younger than age 20 or older than 55.
Most of the time, lumbar radiculopathy and other lower back pain resolves spontaneously after a few weeks, so imaging is not needed. If pain lasts for longer than six to eight weeks or if the symptoms worsen, however, doctors will likely schedule an MRI, which is the gold standard for finding the cause of lower back pain.
Some patients are unable to undergo an MRI, and a CT scan is the alternative. CT scans are somewhat limited as they cannot capture tumors or soft tissue clearly. X-rays are also useful. They can quickly and easily detect fractures, bony abnormalities, and other age-related changes to the spine. It is often difficult to diagnose lumbar radiculopathy using only imaging, so the physician may also order nerve conduction tests.
Treatment for lumbar radiculopathy depends on the cause. Nonsurgical interventions are the first line of treatment — they are always attempted before doctors consider surgery and are successful in most cases. They include anti-inflammatories and opioids medications for pain relief, weight loss to relieve pressure on the nerve, steroid injections to reduce inflammation, and physical therapy to strengthen the muscles surrounding the damage.
When non-surgical treatments do not provide relief, surgery is an option. In most cases, physicians consider surgery if the patient has attempted other treatments for four to eight weeks with no pain relief. Even so, some doctors will avoid recommending surgery, as research indicates that most patients, surgical and non-surgical, see an improvement in their conditions over two years.
About 80 to 90 percent of people who experience lumbar radiculopathy pain recover without surgery. People who experience severe symptoms do benefit from surgery. One study shows that, at eight years after the onset of symptoms, the people who benefit the most from surgery included those who had significant pain and symptoms lasting longer than six months.
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