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Lumbar Radiculopathy

Condition: Lumbar radiculopathy refers to any disorder that affects the nerve roots in the spine in the lower back. Resulting nerve pain that radiates down the back of the legs is also called sciatica.

Background: Lumbar radiculopathy is typically caused by compression of the nerves due to inflammation, “wear and tear”, or trauma. Disk herniation, cysts, and narrowing of the spinal canal cause the majority of cases.

Risk Factors: Lumbar radiculopathy is slightly more common in men, and peak age at time of disk surgery is 40 years. Other risk factors include driving occupations, frequent lifting, heavy industry work, back trauma, taller height, smoking, overweight, sedentary lifestyle, multiple pregnancies, history of back pain, and chronic cough. Environmental factors account for most cases of sciatica, although family history of herniated disks is also a risk factor.

History and Symptoms: Pain is typically described as throbbing, aching, sharp, dull, burning, pressure, numbness, tingling, or shooting. Back pain is usually present, but leg symptoms are the primary problem. History of substance abuse, family history of back problems, work injury, and lifestyle are important to consider.

Physical Exam: A physical exam will be performed to assess the intensity and exacerbating/alleviating factors as well as strength, reflexes, sensation, walking ability, hip range of motion, and presence of other disease symptoms. The patient’s disability will also be assessed using common questionnaires.

Diagnostic Process: X-rays can be used to screen for other problems, such as fractures. MRI and CT scans are used primarily to confirm a diagnosis or in cases where rehabilitation is unhelpful. Electromyography can be used to record the electrical activity of the muscles and diagnostic injections of medications can also be used.

Rehab Management: The majority of patients (70-80%) experience improvement in pain and disability in 4-6 weeks with relative rest and activity modification, and only 1-10% of patients will require surgery. Rehabilitation management emphasizes return to activity. Heat, ice, electrical stimulation, and medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, are often used. Exercise training to develop stabilization of the trunk as well as upper and lower body strengthening and flexibility is useful. Epidural injections of steroids or surgery are used in cases where other treatment is not successful. Chronic pain can be treated with acupuncture, massage therapy, and chiropractic manipulations.

Other Resources for Patients and Families: Patients and families should be educated about rehabilitation, the benefits of exercise, the potential for surgery, and the recurrent nature of the condition.

 

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