Lumbar Radiculopathy is a medical team used to describe a condition where there is pain, numbness or weakness of your buttock and legs. Sciatica is a generally used common term when the pain travels down the back of the leg from your back. It is also used to indicate a ‘pinched nerve’ in your back. All these mean the same thing. Your back has many nerves that branch away from the spinal cord through the exit canals (foramen) of the spine to supply the sensation and power to both your legs.
Sometimes the problems in your back can ‘pinch’ a nerve that comes out of the spine. As this nerve runs travels down your legs, this causes pain also to travel through your whole leg. It affects the buttock, thigh, leg or your feet.
What triggers Lumbar Radiculopathy?
There is enough evidence in the medical literature that depression can lead to the increased production of chemicals that cause pain and inflammation. These chemicals are proteins called ‘cytokines’ These are seen in higher levels in depressed patients. These can cause inflammation of the muscles, joints and tissues in the lower back causing muscle pain, fatigue and low back spasm and stiffness.
Herniated (slipped) Disc in the back:
This is the most common cause of lumbar radiculopathy. Here the disc in your back may bulge or rupture and cause irritation or compression of the nerve coming out of the exit canals in your lower spine.
Disc Degeneration:
This is a condition where the lumbar disc wears out and loses water and height. This traps the nerve coming out of the exit canals in your lower spine.
Lumbar Stenosis:
This is nothing but narrowing of your lower back spinal canal and the side holes in canal that lets the nerves out of the spinal cord. This also traps the nerves causing lumbar radiculopathy.
How does lumbar radiculopathy develop?
A single event or injury does not cause lumbar radiculopathy. It develops slowly over time as the disc degeneration, bulge or rupture takes time. Occasionally, they are sudden. These cause radiculopathy by:
Chemical Inflammation:
When your lumbar disc ruptures, it releases a chemical irritant that leaks out and inflames the nerves that supply your back and leg. This irritation stimulates the pain fibres along the nerve and causes sharp and shooting pains along your leg. There may also be tingling and numbness over your leg.
Direct Compression:
If the lumbar disc bulges, it puts pressure on the nerves in the back that supply your leg. This blocks the feeling that comes from your feet and leg to the brain. You feel this as numbness of that part of the leg. The extent to which the disc presses on the nerves causes worsening numbness and weakness of your buttock, thigh, leg or your feet.
When does lumbar radiculopathy usually happen?
Lumbar radiculopathy affects people of all ages but it is most common between 40-50 years of age. It is more common in people who do strenuous jobs where there is excessive force and strain on their discs due to repeated forward or sideways movements. In most cases, the radiculopathy settles within 4 to 6 weeks. If the radiculopathy progresses to cause numbness and weakness, then a caudal epidural injection, nerve root injection, surgery may be necessary.
What are the first signs of lumbar radiculopathy?
Lumbar radiculopathy starts with back pain and travels to your leg. You will feel a rope like painful sensation starting at the lower back that goes down along your leg to the foot. This can be associated with a burning or tingling sensation in your foot. These symptoms will make sitting, standing and walking very difficult and it may get worse with these activities.
What are the types of Lumbar radiculopathy?
Acute Radiculopathy:
If the pain, numbness, tingling or weakness lasts only less than 6 weeks, it is called ‘acute radiculopathy’. Fortunately, most symptoms last only between one to two weeks. It resolves itself with simple measures like rest and pain killers (anti-inflammatories) within a few weeks. You will be able to get back to normal activities with occasional pain in your back and probably leg. Some people develop numbness along the arm after the pain has subsided. If it lasts longer than 6 weeks then it is called ‘chronic radiculopathy’.
Chronic Radiculopathy:
So, this pain, numbness, tingling or weakness has now lasted more than 6 weeks. Chronic lumbar radiculopathy is known to recur a few times in a year and happens at regular intervals too. Chronic radiculopathy is less severe than acute radiculopathy but it can become a life-long problem. The methods to treat chronic radiculopathy is far different from acute radiculopathy.
How do you manage Lumbar radiculopathy?
Managing Acute Radiculopathy:
The way acute and chronic radiculopathy managed is very different from each other.
There are gentle and simple stretches that you can do during your low back pain episode.
Alternate cold or hot compress packs can help relieve your back and leg pain.
Simple over the counter pain killers like Neurofen and paracetamol can help reduce the pain and encourage early movement of your back and mobility
Do not sit or lie down for longer periods of time
Physiotherapy exercises will help control and manage the pain along with medications.
If the pain persists then epidural steroid injections, nerve root injections can be considered after a scan.
Managing Chronic Radiculopathy:
This is totally different from the way ‘acute radiculopathy’ is managed. The pain changes the way it affects you and can cause anxiety.
Anti-inflammatory medications along with nerve medications that calms your inflamed nerve is used initially.
Physiotherapy in addition to medications helps in the mobility and to get back to normal function.
Trail steroid Injections around the nerve can settle the symptoms by reducing the inflammation.
I will consider surgery only if all the above measures fail and if your symptoms are worsening or if there is progressive numbness and weakness in your leg and foot.
What can make lumbar radiculopathy worse?
Any sudden jerky movements that stretch the nerve will make your radiculopathy worse. This causes the chemicals from the soft disc (cushions) between your spine bones to leak out and irritates the nerve going down leg and feet. Also, unexpected actions like coughing, sneezing, heavy lifting, when getting out of bed will make your radiculopathy worse.
What happens if radiculopathy is left untreated?
There is a prolonged pressure on the nerve and this causes the nerve to stop working. The main function of the nerve is to conduct the signals from the brain to your legs. Therefore, there is numbness and weakness along your legs and this is likely to become permanent. If left untreated, it will then take a long time for the nerve to get back its function and your sensation or power in your legs may not return to normal.
Is Lumbar radiculopathy dangerous?
It can be dangerous when both your legs are involved. This means that the block in your spinal canal affects not just one leg but both legs. These nerves also supply the muscles around the opening of our bladder and bowel. When these nerves are blocked, they can work the openings of your bladder and bowel and therefore, you lose control. This is called ‘Cauda Equina Syndrome’.
This is an emergency and will need immediate medical attention in a casualty setting. You are advised to call the ambulance and seek help as soon as possible.