Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve. Radiculopathy is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy), but can occur in any part of the spine.
Lumbar radiculopathy is nerve irritation caused by damage to the discs between the vertebrae. The damage to the disc can occur due to a variety of factors, including degeneration (“wear and tear”) of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized pain of “sciatica” that shoots down the leg. This type of pain is often deep and steady, and can usually be reproduced with certain activities and positions, such as sitting or walking.
What are the Causes?
Lumbar radiculopathy is typically caused by compression, inflammation and/or injury to a spinal nerve root in the low back. Causes of this type of pain, in the order of prevalence, include:
- Herniated disc with nerve compression – by far the most common cause of radiculopathy
- Foraminal stenosis (narrowing of the hole through which the spinal nerve exits due to bone spurs or arthritis) – more common in elderly adults
- Nerve root injuries
- Scar tissue from previous spinal surgery that is affecting the nerve root
What are the Symptoms?
The most common symptom of radicular pain is sciatica (pain that radiates along the sciatic nerve – down the back of the thigh and calf into the foot). Sciatica is one of the most common forms of pain caused by compression of a spinal nerve in the low back. It often will be caused by compression of the lower spinal nerve roots (L5 and S1).
With this condition, the leg pain is typically much worse than the low back pain, and the specific areas of the leg and/or foot that are affected depends on which nerve in the low back is affected. Compression of higher lumbar nerve roots such as L2, L3 and L4 can cause radicular pain into the front of the thigh and the shin.
Numbness and tingling, muscle weakness and loss of specific reflexes may also accompany radicular pain.
What are the Treatments?
Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management through nonsurgical treatments is usually recommended for six to eight weeks. Treatments can include patient education, medications to relieve pain and muscles spasm, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding re-injury).
If nonsurgical treatment does not alleviate the pain, decompressive surgery, such as laminectomy and/or discectomy/microdiscectomy, may be recommended. This type of surgery typically provides relief of radicular pain/leg pain for 85% to 90% of patients. The operation performed depends on the overall status of the spine, and the age and health of the patient.