Lumbar radiculopathy is a condition characterized by compression or irritation of nerve roots in the lumbar spine, resulting in radiating pain, numbness, and weakness along the distribution of the affected nerve.
The lumbar spine consists of five vertebrae (L1-L5) with intervertebral discs and neural foramina through which nerve roots exit. Radiculopathy occurs when these nerve roots are compressed or irritated, typically due to herniated discs, degenerative disc disease, spinal stenosis, foraminal stenosis, or spondylolisthesis.
Patients typically present with radiating pain following a dermatomal pattern, lower back pain that may extend to buttocks, legs, or feet, numbness or tingling in affected dermatomes, muscle weakness in corresponding myotomes, positive straight leg raise test, exacerbation with certain movements or positions, and diminished reflexes.
Clinical examination includes detailed neurological examination, motor strength testing, sensory examination, deep tendon reflexes, and special tests (straight leg raise, crossed straight leg raise). Imaging studies include MRI as the gold standard for visualization of nerve root compression, X-rays to assess alignment and degenerative changes, CT scan when MRI is contraindicated, and EMG/NCS to confirm radiculopathy and determine severity.
Conservative treatment includes activity modification, physical therapy, NSAIDs, muscle relaxants, short-term oral corticosteroids, and epidural steroid injections. Surgical intervention is considered when conservative treatment fails, there are progressive neurological deficits, severe pain unresponsive to conservative measures, or cauda equina syndrome. Surgical options include microdiscectomy, laminectomy, foraminotomy, and spinal fusion in selected cases.
Most patients improve with conservative treatment, with an 80-90% success rate with appropriate management. Recovery time varies from weeks to months. Risk factors for poor outcomes include prolonged symptoms before treatment, smoking, obesity, diabetes, and worker’s compensation cases.
Prevention strategies include proper body mechanics, core strengthening exercises, ergonomic workplace modifications, weight management, regular exercise, and smoking cessation.
Follow-up care involves regular monitoring of symptoms, assessment of treatment response, adjustment of management plan as needed, return to work planning, and prevention of recurrence through lifestyle modifications.
This comprehensive approach to lumbar radiculopathy emphasizes accurate diagnosis, appropriate staging of interventions, and individualized treatment planning to optimize outcomes.
