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Lumbar Radiculopathy

A pain that begins in the lower back, radiates out from the buttocks through the back of the thigh and calf, and sometimes down into the feet is the classic sign of lumbar radiculopathy (aka sciatica). Numbness, pain or weakness in different parts of the leg and foot are also commonly reported. Lumbar radiculopathy can be as innocuous as a feeling of pins and needles, but it can also be excruciating and debilitating as well.

Fortunately, most incidences of lumbar radiculopathy do not require surgery and can be ameliorated by a combination physical therapy, rest and, in some cases, medication. Alternative therapies have also been known to provide relief. If you suspect you are suffering from this condition, contact the Ainsworth Institute of Pain Management for a consultation.

Lumbar Radiculopathy is often mistaken for a disease or condition in itself. It actually refers to symptoms created by any compression or irritation of the sciatic nerve, the longest and widest nerve in the human body, and can be caused by a wide variety of factors.

What is Lumbar Radiculopathy?

Lumbar Radiculopathy, also called Sciatica, refers to the pain causedSciatic Nerve Inflammed by the compression or irritation of one, or several of the nerves in the lumbar spine. These nerves start in the lower back and travel downward through the buttocks, along the leg and into the feet. They are important as they send signals to your muscles and provide your nervous system’s connection to the skin and muscles of the thighs, calves, and feet.

There are five lumbar nerve roots in the spinal cord. When compression or irritation occur at or near these roots, it is often experienced as a pain that “radiates” down the legs. This can result in pain, weakness, numbness or difficulty controlling specific muscles, particularly in a distribution specific to the affected nerves.

Symptoms

Along with the aforementioned lower back pain that travels down the length of the leg, other common symptoms include:

Pain; mild ache to sharp and excruciating
Electric shock-like pain
Pain aggravated by a cough or sneeze, or when sitting
Burning, numbness, tingling, or pins-and-needles sensations
Muscle weakness
Loss of bowel and/or bladder control* (uncommon)

*Loss of bowel and/or bladder control may be a symptom of cauda equina syndrome, a serious medical condition. Seek medical care immediately if you experience a loss of bowel or bladder control.

What are the Causes?
Sciatica Causes

Lumbar Radiculopathy can develop as a result of back injury or various lifestyle habits. Some of these include:

Spinal trauma (i.e. falling or accident)
Poor biomechanics (i.e. lifting, carrying things incorrectly)
Prolonged sitting
Unhealthy lifestyle: being sedentary, using tobacco, poor diet, alcohol abuse

In addition, a variety of conditions unrelated to overuse, injury, or lifestyle can also associated with lumbar radiculopathy. These include:

Diabetes
Normal aging and spine degeneration (i.e. disc degeneration)
Disc Herniation
Bone Spur
Spinal Stenosis
Pregnancy

Any of these factors can cause compression or irritation of the lumbar or sacral nerve roots, and result in any of the above pain symptoms.

What are my Treatment Options?

shutterstock_242888263Diagnosis of lumbar radiculopathy should only be made by an expert physician. In most cases the doctor will be able to diagnose with nothing more than your medical history and a thorough physical examination. He/she will most likely want to know when your symptoms began, their severity, what treatments you have previously tried, and what were the results.

In the physical examination, the doctor will examine the patient for limitations of movement, balance problems, and pain. He/she may also test reflexes in the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.

If needed, an x-ray is obtained to rule out more serious conditions, such as a herniated disc in the lower back, tumor, or other problem.

Lumbar radiculopathy can heal without treatment and surgery is rarely needed. If treatment is prescribed, it is usually a combination of therapy and medication.

Nonoperative Treatments can include:
 Short-term rest
 Cold & Hot Therapy
 Physical Therapy
 Acupuncture
 Massage

Medications for Lumbar Radiculopathy can include:
 Over-the-counter or prescription pain medication
 Anti-inflammatory medication
 Muscle relaxant medication

Interventional Pain Management Treatments
Interventional techniques can be a faster and more definitive method of pain relief for lumbar radiculopathy. These treatments are useful in the presence of severe pain that has failed conservative medical treatment and/or medication.

Lumbar Epidural Steroid Injection – This procedure is considered by many to be the “gold-standard” treatment for lumbar radiculopathy. It is basically the same as a woman will receive during childbirth.  Under fluoroscopic guidance, your physician will place a small needle into the epidural space and inject a small amount of medication to eliminate the pain.

Transforaminal Epidural Steroid Injection – This procedure is similar to the one above; however, in this case the medication is focused directly onto the nerve fibers that make up the sciatic nerve – the result is more medication delivered to the affected area.

Spinal Cord Stimulation (SCS) When the inflammation in and around the affected nerves is too great for an epidural injection, SCS is an excellent and effective treatment option that can eliminate the pain without surgery. In SCS, an electrical pulse is delivered directly to the spine, blocking certain neuron fibers’ access to the brain and consequently the brain’s ability to sense the previously perceived pain. 

MicrodiscectomyAnother option in cases where the  inflammation in and around the affected nerves is too great for an epidural injection.  With microdiscectomy, some of the damaged material around the nerve(s) is removed.

Surgery:
In a minority of cases, the cause of a lumbar radiculopathy may be something that requires surgery to fix. The presence of neurological deficit, cauda equina syndrome (i.e. loss of bowel and/or bladder control), or other problems, may require a surgical intervention.

Prevention Steps:
Part of treatment will be learning healthy spine habits and making lifestyle changes which may reduce current symptoms and prevent further attacks.

Schedule an Appointment Today

Our doctors at the Ainsworth Institute of Pain Management are experts in using the most cutting edge and advanced methods for treating lumbar radiculopathy. Call and schedule an appointment today with one of our board-certified pain management doctors and find out what treatment options would best suit your symptoms.

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