Lumbar radiculopathy and back pain

Lumbar radiculopathy is manifested by a combination of symptoms, including neuropathic pain in the back and lower limb, generated in the lumbar spinal roots. Additionally, numbness, weakness, and loss of reflexes may occur in patients. The causes of lumbar radiculopathy are herniated disc, narrowing of the intervertebral foramen, osteophytes and rarely - a tumor. Many patients and their doctors call lumbar radiculopathy ishialgia.

[1], [2], [3], [4], [5]

Symptoms of lumbar radiculopathy

Patients with lumbar radiculopathy complain of pain, numbness, tingling and paresthesia in the innervation zone of the affected nerve root or roots. Also, patients can note weakness and impaired coordination of movements in the affected limb. Muscle spasms and pain in the back are often noted, pain radiating to the buttocks. On examination, a decrease in sensitivity, weakness and decreased reflexes are found. The symptom of Laceg's tension is almost always positive in patients with lumbar radiculopathy. Sometimes in patients with lumbar radiculopathy, the compression of the cauda equina may develop, in which the weakness of the muscles of the lower limbs and the symptoms of disorders of the bladder and rectum develop. This is an urgent neurosurgical situation, and it should be maintained as such.

The most common lumbar discogenic syndromes

Spine	Interdisk interval	Suffering Reflex	Motor weakness	Sensory disturbances (if any)
L4	L3-L4	Knee	Extension in the knee joint	The front surface of the thigh
L5	L4-L5	Reflex popliteal muscles	Extension of the thumb	Thumb
S1	L5-S1	Achilles (ankle) reflex	Flexion (plantar flexion) of the foot	Lateral edge of foot

Complications and Diagnostic Errors

Errors in the diagnosis of lumbar radiculopathy can lead to the development of lumbar myelopathy, which in the absence of treatment can progress to paraparesis or paraplegia.

It is necessary to differentiate the tarsal tunnel syndrome, the compression of the lumbar nerve from lumbar radiculopathy, which affects the lumbar nerve roots. It should be remembered that lumbar radiculopathy and neuropathy of the lumbar nerve can coexist with the syndrome of "double compression".

[6], [7], [8], [9], [10], [11], [12]

Examination

MRI provides the most complete information about the lumbar spine and its contents, it should be performed by all patients with suspicion of lumbar radiculopathy. MRI is highly reliable and can identify pathology that can cause lumbar myelopathy. For patients who can not pass an MRI (presence of pacemakers), CT and myelography are a reasonable alternative. If a fracture or bone pathology is suspected, such as a metastatic disease, radionuclide bone scanning (scintigraphy) or rontgen radiography is indicated.

While MRI, CT and myelography provide useful neuroanatomical information, electromyography and study of nerve conduction velocity - neurophysiological data on the current state of each nerve root and lumbar plexus Electromyography can also help in distinguishing between plexopathy and radiculopathy, identifying the concurrent tunneling neuropathy, As a garzal tunnel syndrome, which can make diagnosis difficult.

If the diagnosis of the cause of lumbar radiculopathy is in question, a laboratory examination should be conducted, including a general blood test, ESR, the determination of antinuclear antibodies, HLA B-27 antigen and blood biochemistry to determine other possible causes of pain.

[13], [14], [15]

Differential diagnosis

Lumbar radiculopathy is a clinical diagnosis, supported by a combination of anamnesis, examination, radiography and MRI. Pain syndromes capable of simulating lumbar radiculopathy include myogenic pain, lumbar bursitis, lumbar fibromyositis, inflammatory arthritis and diseases of the lumbar spinal cord, roots, plexus and nerves.

[16], [17], [18], [19], [20], [21]

Treatment of lumbar radiculopathy

In the treatment of lumbar radiculopathy, the multicomponent approach is most effective. Physiotherapy, consisting of thermal procedures, and a deep relaxing massage in combination with NSAIDs (eg, diclofenac or lornoxicam) and muscle relaxants (eg, tizanidine) are justified as a starting treatment. If necessary, you can add caudal or lumbar epidural block. Blockade of nerves with local anesthetics and steroids can be highly effective in the treatment of lumbar radiculopathy. Sleep disorders in depression are best treated with tricyclic antidepressants, such as amitriptyline, which can be started with 12.5 mg once a day before bedtime.