When you experience pain that radiates from your back down to your legs, the condition is called lumbar radiculopathy, also referred to as sciatica. The pain may radiate down one or both legs. It may travel down the front, back or side of the leg. It may involve the foot and toes, or it may stop anywhere in the leg.
Sciatica can be quite disabling and is responsible for more than 100 million lost days of work per year. Somewhere between 75 percent to 80 percent of adults will experience low back pain at some point in their lives, usually from muscle strain.
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What Are the Causes of Lumbar Radiculopathy?
Risk factors for sciatica pain include smoking, obesity – particularly excess weight around the abdomen – and repetitive motion, such as that found in some occupations. Some other common causes of low back pain include spinal disc injury, degeneration (aging or drying) of the disc and lumbar stenosis. Additional causes include compression fractures and spinal tumors.
How Is Lumbar Radiculopathy Diagnosed?
To diagnose radiculopathy, a neurosurgeon will use a combination of a complete medical history, a physical examination, and appropriate radiological imaging.
In many cases a magnetic resonance imaging scan (MRI) is indicated. Other tests may be necessary, including computed tomography (CT or CAT scan), electromyelogram (EMG), myelogram or discogram. An EMG involves inserting needles into nerves on the arms or legs, a myelogram involves contrast dye injected into the spinal column prior to X-ray, and a discogram involves inserting a needle and injecting dye into the disc.
What Are the Treatment Options for Lower Back Pain?
The good news is that the majority of back pain patients will recover with conservative lumbar radiculopathy treatment, and surgery is not necessary. All patients will need to make routine exercise and proper body mechanics part of their everyday lifestyle to reduce the risk of injury.
Initial treatments for lower back pain is focused on pain relief and return to work and daily activities. Medications such as non-steroidal anti-inflammatories may reduce swelling and thereby discomfort. Physical therapy and exercises to stretch and strengthen the lower back and abdomen may be beneficial. In many cases, epidural steroid injections (ESIs) may provide relief of discomfort. The treatments are individualized based upon the patient’s symptoms.
If the radicular pain persists despite conservative therapy, surgical intervention may be considered. The specific type of surgery will vary depending upon the structural defect.
Possible surgeries include a lumbar microdiscectomy, lumbar laminectomy or spinal fusion with or without instrumentation. Microdiscectomy involves removing a disc with the aid of a surgical microscope. Laminectomy is removal of vertebral bone. Spinal fusion uses bone chips, with or without screws, rods or metal cages, to fuse together two vertebrae after the disc in between has been removed.