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Lumbar Radiculopathy  ( Sciatica )

Lumbar radiculopathy is also known as sciatica.  It is a condition resulting from either herniated disc or a narrowing of the spinal exit to a particular nerve. Lumbar spondylolisthesis and spinal stenosis present with leg pain as well. Pain can be acute or chronic and may involve one or both legs.

 

Pain may start in the lower back or buttocks and may develop into leg pain. It could have a mild presentation of leg heaviness, numbness, tingling, and burning, or could be severe electrical shooting pain as well as weakness and imbalance. The most common lumbar radiculopathy is L4/5 and L5/S1. Classic sciatica is radiating back pain to the calf and the foot (S1 Radiculopathy). The most classic type is back pain, buttock pain, and hamstring pain radiating to the foot. With examination,  your spine specialists can often determine which nerve root is impinged upon.

 

How to Diagnose Sciatica?

Generally, if the initial physical exam by your spine specialist is without evidence of neurological deficit, the patient will spend 6 weeks in physical therapy before ordering advanced imaging such as MRI.  The first diagnostic test is usually an x-ray. The most accurate clinical test to identify a herniated disc is an MRI. Some patients are unable to have an MRI, in which case a CT scan and EMG test will help make a diagnosis. 

Conservative Treatment 

If there are no alarming neurological deficits, conservative treatment is recommended

 
1.  Physical therapy 6 weeks
2.  Trial of anti-inflammatory medication such as ibuprofen
3.  Trial of medication such as Tylenol
4.  Trial of oral prednisone taper  (oral Steroid)

Procedural treatment:

If physical therapy and a trial of NSAIDs do not help, MRI will be ordered. If the symptom correlates with the MRI finding, interventional procedures can be offered.  These are x-ray-guided  (non-surgical) procedures that could result in pain relief and functional recovery. These procedures are performed in an office setting. 

  1. Lumbar epidural injection

  2. Lumbar transforaminal injection

  3. Percutaneous lumbar discectomy

 

The effect of an epidural injection may last several weeks to several months. If the symptom(s) return, such treatment could be repeated. There is no indication for long-term use of narcotic medications for lumbar radiculopathy.

Surgical Treatment 

Persistent pain, bowel and bladder dysfunction, progressive weakness, and frequent falls despite conservative care are among the indications for surgery. A careful risk assessment should be done by a primary care physician, spine surgeon, and the patient before considering surgery. In most cases, the patient would benefit from laminectomy, discectomy, foraminotomyand in some cases spinal fusion. The surgery takes a few hours to complete, with a short course of inpatient hospitalization and a few weeks of outpatient rehabilitation after discharge from the hospital. Fusion is indicated if there is spine instability. Fusion has a longer course of recovery.