Lumbosacral radiculopathy is a common condition involving spinal nerves and nerve roots in the low back (lumbar) and bottom of the spine (sacrum). It affects 3–5% of the population, men and women equally. Men in their 40s and women 50–60 years old have it most often. It’s a major cause of disability and the primary reason for workers’ compensation disability in the United States.
Pressure from herniated (ruptured, or slipped) disks lead to irritation and inflammation (swelling) of nerve roots. Disk degeneration is another cause. Disks are cartilage pads that separate bones (vertebrae) in the spine. These shock absorbers cushion moving vertebrae. With age, the tough disk covering can tear. The jelly-like substance in the disk center can seep out (herniate), press on nerve roots, and cause symptoms. Other causes are spinal stenosis (narrowing), tumors, infections, and trauma.
Symptoms include pain and numbness in the arms or legs and muscle weakness. The most common symptom is sciatica: pain that goes along the path of the sciatic nerve, the longest nerve in the body. This nerve runs from the back down the buttock and leg (back of the thigh and calf). Sciatica is a symptom of a problem such as a herniated disk. Other symptoms are numbness, tingling, and loss of bladder or bowel control.
The health care provider takes a medical history and does a physical examination, especially of the spine and legs, and checks muscle strength and reflexes. Because most people improve with rest, self care, and medications, imaging tests are not always needed. For persistent pain, magnetic resonance imaging (MRI) is the main imaging test. X-rays, computed tomography (CT), myelography, and electrodiagnostic studies (e.g., nerve conduction) are also used.
Most people need no treatment, or pain goes away with self-care measures. These include hot or cold packs, stretching, exercises, and over-the-counter pain medicines. Physical therapy helps recovery; prolonged bed rest is not recommended. People need to get moving as soon as possible. Rehabilitation can help prevent new injuries. For more chronic, nondisabling pain, lifestyle changes with weight loss and health club membership are best. Exercises correct posture, strengthen back muscles, and improve flexibility. Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, analgesics, and steroid injections may be given. If these treatments don’t work, or for certain symptoms, surgery is needed.
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