Lumbar Radiculopathy and Sciatica
Back pain is a common condition affecting approximately 80% of the population at some point in their lives. The area usually affected is the lower back (lumbar region) as it bears most of the upper body’s weight. Pain in the lower back may sometimes radiate to the legs. This is referred to as lumbar radiculopathy or sciatica. Lumbar radiculopathy can be extremely debilitating and interferes with your daily activities.
To understand lumbar radiculopathy, you need to know a little about spinal anatomy. The spine consists of 33 vertebral bones stacked one on top of the other with cushioning discs lying between each vertebra. The lumbar region of the spine (below the rib cage) consists of 5 vertebrae. Nerves of the spinal cord in this region communicate with the lower body through spaces between the vertebrae. Trauma to the spine, age and overuse can result in deterioration of the vertebral bones and joints or bulging of the discs. The resultant loss of space can lead to compression of the spinal nerve roots. Depending on the area being supplied by the nerve, symptoms are experienced in the lower extremities.
Common symptoms include a sharp or burning pain that travels down one leg. Other symptoms include numbness, tingling and muscle weakness. Occasionally, leg pain occurs without the back pain. A thorough evaluation is necessary to identify your spine as the actual source of your pain.
Your symptoms and history are reviewed and a detailed physical examination is performed. If the pain originates in the spine, it usually follows a specific pattern of distribution that your doctor identifies and correlates with a spinal level or nerve root. Imaging studies are performed to confirm the diagnosis.
Most cases of lumbar radiculopathy are transient and can be treated by conservative methods such as rest, activity limitation, anti-inflammatory medications, spinal manipulation, spinal injections, physical therapy, specific home exercises and other modalities. A specific treatment plan is formulated to effectively relieve your symptoms and ensure a quick return to your regular activities. If symptoms are severe or persistent surgery may be recommended.
Sciatica is a painful condition caused by the irritation of the sciatic nerve. The sciatic nerve is the longest nerve in our bodies. It begins in the lower back and extends through the buttocks down the back of each leg to the thighs and feet.
Sciatica can be acute (short term) lasting a few weeks or chronic (long term) persisting for more than 3 months. It is important to understand that in most cases sciatica will resolve itself within a few weeks or months and rarely causes permanent nerve damage.
Anyone can develop sciatica at some point in their lives; however, there are certain risk factors that may predispose you to develop sciatica. These include the following:
- Increased age
- Poor physical fitness or inactive lifestyle
- Occupational risks
- Poor nutrition
- Medical conditions such as diabetes or cancer that has metastasized to the spine can cause sciatica
It is important to know that sciatica is a symptom but not a medical diagnosis. Some medical conditions that can cause sciatica include herniated discs, lumbar spinal stenosis, piriformis syndrome, spondylolisthesis, degenerative disc disease, diabetes, tumors and trauma.
The most common symptom of sciatica is pain. The pain can vary from mild to debilitating depending on the degree of pressure exerted on the sciatic nerve. Patients having sciatic nerve experience other symptoms such as:
- Pain in the buttock area and leg
- Sharp, intense, shooting pain down the leg
- Numbness, burning or tingling sensation in the leg or foot
- Weakness of the leg or foot
- Low back pain that radiates down to the buttock and leg
- Pain increases with coughing, sneezing or straining
- Pain increases with bending backward and with prolonged sitting or standing
Sciatica will be diagnosed by studying the complete medical history, a physical examination, assessment of neuromuscular function and diagnostic procedures such as X-ray, MRI, CT scan, CT scan with myelogram, electromyogram and nerve conduction tests.
Sciatica can be treated with conservative treatment approaches such as physical exercises, over the counter drugs, ice or hot packs, prescription medications, epidural steroid injections, massages and manual manipulation. In some cases, surgery may be recommended to treat the underlying condition causing sciatica and these conditions include herniated discs, lumbar spinal stenosis, spondylolisthesis and degenerative disc disease.