Lumbar spine radicular syndrome

Symptoms that occur when the nerve roots of the spinal cord are compressed in the spine - in the lumbar region, in neurology can be defined as radicular syndrome of the lumbar spine.

Although the more modern medical variant of this term is lumbar or lumbar (from Latin lumbus - lumbar) radiculopathy, which patients are accustomed to calling radiculitis. [1]

Epidemiology

According to clinical statistics, the prevalence of lumbar radiculopathy, which is a consequence of herniated vertebral discs - lumbar spinal herniation and radicular syndrome, ranges from 3 to 11%, and the

95% of cases of herniation occur in the L4/L5 or L5/S1 intervertebral spaces.

According to some data, lumbosacral radiculopathy affects 10-25% of people in the older age group. And at the same time, on average, 7.5% of patients are diagnosed with intervertebral herniation in the L5-S1 vertebrae.

Causes of the lumbar radiculopathy

Radicular or radicular syndrome is a neurological pathology, and the key causes of lumbar radiculopathy (from Latin radix nervi spinalis - spinal nerve root) are irritation or compression of the nerve roots that exit the spinal cord into the vertebrae of the lumbar region. Compression of the roots can occur:

• due to disc herniation of the LI-LV vertebrae of the lumbar region;
• due to narrowing of the spinal canal, i.e. spinal canal stenosis;
• Foraminal stenosis is a narrowing of the spinal opening (foramen vertebrale) through which each spinal nerve passes;
• in patients with spondyloarthritis (deforming osteoarthritis of the spinal joints).

Root compression is possible in lumbosacral osteochondrosis, i.e. Lumbar osteochondrosis with radicular syndrome.

This syndrome can also be caused by:

• Abnormal curvature of the spine in scoliosis (particularly lumbar S-shaped scoliosis) and other deforming dorsopathies;
• Spondylolisthesis, that is displacement of the lumbar vertebrae;
• The presence of a cyst or tumor mass in the lumbar region of the spinal column.

Risk factors

Risk factors for lumbar radiculopathy are considered to be: spinal injuries; excessive or repetitive physical stress on the spine (frequent heavy lifting, vibration, some sports); age after 45 years; spinal diseases; overweight; sedentary lifestyle; family predisposition to lumbar disc herniation. [2]

Pathogenesis

All spinal nerves are formed by a combination of nerve fibers of two types of roots: dorsal afferent sensory and ventral - efferent motor. They transmit motor (motor), sensory and autonomic signals, providing sensory perception (sensitivity) and movement of the lower limbs.

The pathogenesis of the development of symptoms of compression of the dorsal and ventral roots of the spinal cord is explained by the fact that when they are irritated, excessive nerve impulses (action potentials of hyperpolarized neurons) arise - from the body to the spinal cord and brain and from the brain to peripheral receptors. This leads to disinhibition of synaptic transmission and formation of new nerve connections that form sensations of pain, numbness and tingling in the innervation zone of a particular nerve root. [3]

Symptoms of the lumbar radiculopathy

The first signs of lumbar radicular syndrome manifest themselves in the form of pain (increasing with movement), tingling and numbness of the dermatome - sensory disturbance of the skin area, which is innervated by the compressed root.

Symptoms also include weakness of the gluteal muscles on the affected side and lower extremity muscles, and impaired muscle reflexes in the legs and feet.

For example, in case of root compression at the level of the lumbar vertebra L4, patients experience numbness of the anterior surface of the thigh (going down to the knee), problems with bending the leg at the knee due to weakening of the knee reflex. And loss of sensation and difficulty in extending the big toe of the foot are indicators of root compression at the level of the lumbar vertebra L5.

Lumbosacral radicular syndrome - when the roots are compressed not only at the level of the lumbar vertebrae, but also at the level of the sacral vertebrae (S1-S4) - is manifested by pain in the gluteal region and thigh, which can be defined as sciatica (from Greek ischion - thigh). There may also be irradiating pain, numbness, muscle weakness, and gait disturbances of varying severity (in the form of neurogenic claudication).

Lumbar dorsopathy with radicular syndrome as well as compression lumbalgia lumbar spine means only that the patient feels pain in the lumbar spinal column and reflected pain due to pinching of the roots of spinal nerves. With simultaneous compression of their trunks, the diagnosis can be defined as radiculoneuritis. And in cases where the bulging of the intervertebral disc in the lumbar region manifest themselves in the form of acute attacks of pain, determine lumbago. [4]

More details:

• Lumbar radiculopathy and back pain
• Radiculitis
• Spine syndromes and back pain

Complications and consequences

In cases of lumbar and lumbosacral radicular syndrome there are such consequences and complications as weakening of muscle tone of the affected areas, as well as damage to the myelin sheath of nerves - myelopathy, leading to paraparesis with sensory disturbances or partial/complete paralysis of the lower extremities, which is accompanied by pelvic organ dysfunction.

Diagnostics of the lumbar radiculopathy

Diagnosis is usually based on history taking and physical examination with neurologic tests (assessing the degree of loss of reflexes, dermatome sensitivity, and muscle weakness).

Blood tests may be required - general and biochemical.

Instrumental diagnostics are performed:

• X-rays of the spine and spinal cord;
• MRI of the lumbar spine;
• electromyography;
• contrast myelography.

Differential diagnosis

First of all, differential diagnosis should exclude muscular pathologies (which are manifested by myofascial pain syndrome or muscle-tonic lumbalgia), cauda equina syndrome, compression of the posterior tibial nerve (tarsal tunnel syndrome), and neurosarcoidosis.

Treatment of the lumbar radiculopathy

In lumbar radicular syndrome, treatment is aimed at both eliminating the cause of its occurrence and relieving the symptoms of its manifestation.

Specifically, medications are used to manage pain, most commonly non-steroidal anti-inflammatory drugs (NSAIDs).

Read more in the publications:

• Treatment of sciatica
• Ointments for sciatica
• Effective pills for back pain
• Leg pain pills
• Spinal hernia treatment
• Medication treatment of osteochondrosis of the spine

Lumbar radicular syndrome injections involve an epidural blockade using corticosteroids (Hydrocortisone, etc.) in combination with anesthetic drugs, for more information see. - Novocaine blockade.

Sufficiently effective and physiotherapeutic treatment: electro- and phonophoresis, darsonval, low-frequency pulse, magneto- and reflexotherapy, massage, LFK.

Systematically performed exercises for lumbar radicular syndrome help to improve mobility and accelerate the recovery of damaged nerves.

This requires special gymnastics for lumbar radicular syndrome - exercises for the lower back, aimed at stabilizing the spine and strengthening the muscles of the lumbar spine, hips, transverse abdominal muscles.

More information in the material - Spinal lumbalgia treatment: standards, medications, LFK, exercises

To release the nerve root from compression, surgical treatment of lumbar radiculopathy is performed: by laminectomy (in cases of spinal canal stenosis) or discectomy - in cases of disc herniation. [5]

Prevention

Not all risk factors for the development of this syndrome can be prevented, but a sufficient level of physical activity (without increased loads on the lumbar spinal zone) is considered by experts to be almost the only way to prevent it.

Forecast

For most patients with radicular syndrome of the lumbar spine, the prognosis is favorable, but in almost a third of cases, the pain and associated disorders become chronic. And lack of adequate treatment increases the risk of paralysis.