Download Lumbar Radiculopathy - Pinky S. Tiwari, MD, PA

Pinky S. Tiwari, M.D., P.A.
Diplomate, American Board of Neurology
Diplomate, American Board of Electrodiagnostic Medicine
St. Luke’s Medical Tower
6624 Fannin, Suite 2190
Houston, TX 77030
Telephone: (713) 790 – 1775
www.texasneuro.com
Fax: (713) 790 – 1605
LUMBAR RADICULOPATHY
Lumbar radiculopathy is pain in the lower extremities in a dermatomal pattern. A dermatome is a specific area
in the lower extremity innervated by a specific lumbar nerve. This pain is caused by compression of the roots of
the spinal nerves in the lumbar region of the spine. Diagnosing leg and back pain begins with a detailed patient
history and examination.
Medical History
Your medical history helps the physician understand the problem. It is important to be specific when answering
medical questions related to pain onset but remembering every detail is often not critical. Keeping records of
your medical history, including medical problems, medications you are taking and surgeries you have had in
the past is helpful.
Regarding your leg and back pain, it may be helpful to keep a journal of your activities, documenting when the
pain began, the activities that aggravate your pain and those that relieve your symptoms. It is also important to
determine whether your back pain is more bothersome than your leg pain or visa versa. You may be asked if
you are experiencing any numbness or weakness in your legs or any difficulty walking. Remember,
understanding the cause of your problem is based on the information you provide.
Most people describe radicular pain as a sharp or burning pain that shoots down the leg. This is what some
people call 'sciatica.' This pain may or may not begin in the low back. Leg pain caused by compressed nerve
roots generally has specific patterns. These patterns of pain depend on the level of the nerve being
compressed. After reviewing your history, your physician will perform a physical examination. This will help the
physician determine if your symptoms are due to a problem that is caused by spinal nerve root compression.
To help you understand the exam performed by your physician lets pause for a quick anatomy lesson.
Anatomy
The spine is comprised of 33 Vertebrae (bones stacked on top of each other in a "building-block" fashion) that
have 4 distinct regions: Cervical, Thoracic, Lumbar, and Sacral. Discs, cushion-like tissues separate most
vertebrae and act as the spine's shock absorbing system. The disc has a tough outer ring of fibers called the
Annulus Fibrosus and a soft gel-like center called the Nucleus Pulposus.
There are seven flexible cervical (neck) vertebrae that support the head. There are twelve thoracic (chest)
vertebrae, which attach to ribs. The five lumbar vertebrae are large and carry the majority of the body weight.
The sacral region helps distribute the body weight to the pelvis and hips.
The spinal cord is housed within the protective spinal column. Spinal nerves come from the spinal cord and
travel through a tunnel or foramen. The nerves provide sensory (allowing you to touch and feel) and motor
information (allowing the muscles to function) to the entire body
Physical Examination
You may be asked to stand, walk or lie down on the exam table during the physical examination. In a lying
position, your physician will raise each of your legs to demonstrate flexibility and strength in your low back and
legs.
Diagnostic Studies
To further determine the source of your symptoms, and to confirm your diagnosis, your physician may request
other tests such as an X-Ray or MRI (Magnetic Resonance Imaging).
An X-Ray is used to show the bony anatomy of the spine. In an X-Ray, the physician is looking for the
alignment and integrity of the bony structures. Integrity in this sense means no degeneration in the bone
structures.
An MRI produces images of the soft tissues of the spine. Using an MRI, the physician looks at the soft tissue
structures such as the discs, ligaments, spinal cord, and spinal nerves. The physician looks at the integrity of
the discs themselves for degeneration (dark in color because of loss of hydration), bulging or herniation (where
the disc contents protrude into the spinal canal and compress the nerves or spinal cord). If there is a herniation
present, the MRI helps the physician determine if the nerves are being pinched or smashed by the herniated
disc.
Treatment
Low back pain with lumbar radiculopathy is often treated conservatively. This may include a combination of
rest, medication, and a home exercise or structured physical therapy program.
Surgery may be recommended if symptoms persist after conservative treatment. These symptoms may include
severe pain, increasing numbness, or weakness of the legs. The decision for surgical intervention is often
made when conservative treatment has failed and the symptoms are interfering with your daily function
causing lifestyle changes such as an inability to work or participate in the activities you enjoy.
Understanding Lumbar Radiculopathy
A combination of medical history, physical examination, and diagnostic testing helps your physician understand
your symptoms. It is important for you as the patient to understand your symptoms, as well. Understanding
your symptoms allows you to seek treatment when appropriate. Your family physician is an excellent source for
initial assessment and treatment, followed by referral to a spine specialist when necessary.