What is lumbosacral radiculopathy?
Some people have pain, numbness and tingling that may travel into the buttock, leg and into the foot. This can occur when one or more nerves that go from the spine to the leg get pinched or damaged. People sometimes refer to this as having a “sciatica”. Rather than being an actual problem with the sciatic nerve, it is a compression of a nerve in your back (spine).
What are the symptoms?
- Aching or shooting pain travelling into the leg and foot.
- Pins, needles, tingling or numbness in parts of the leg and foot.
- Weakness with certain activities.
- Symptoms can be worsened with coughing, sneezing, or straining.
What causes radiculopathy?
Disc herniation: Rubbery discs sit in between each of the vertebrae (spine bones) to add cushion and allow movement. The discs have a tough outer shell and jelly-like center. The discs can break open and bulge out, causing them to press on or irritate nearby nerves. (A disc that breaks open and bulges is called a “herniated disc.”)
Lumbar spondylosis: Wear and tear changes in the spine can form bumps called bone spurs, which press on nearby nerves. (Often called “spinal stenosis” where the space for the nerve is narrowed)
Sometimes these come on suddenly after heavy lifting. Jobs or activities with repetitive spine flexion predispose to disc herniation. Sometimes there is no specific event that can be identified as causing this.
What tests will I need?
Imaging tests – like an MRI, or CT scans, create pictures of the inside of the body. These imaging tests can show problems with the spine like those described above. These tests are ordered when your doctor thinks you may benefit from injections or surgery.
Electromyography (also called “EMG”) – is a test that checks how the nerves are working. It is used to find nerve damage from lumbosacral radiculopathy as well as other nerve problems that can affect the leg.
How is radiculopathy treated?
In 60% of cases, the radiculopathy goes away as the nerves heal. For most people this lasts anywhere from 3 – 6 months. When people do get treatment, it can include:
Pain medicines that you can get without a prescription like ibuprofen or acetominophen (If these do not work, stronger prescription pain medicines are available like opiate or nerve pain medicines.)
Powerful anti-inflammation drugs called corticosteroids are occasionally presribed for short periods of time to reduce nerve inflammation and give pain relief.
Physical therapy can be helpful to review spine biomechanics (movement patterns), spinal extension exercises, nerve gliding exercises, and occasionally traction.
Sometimes surgery is needed to relieve the pain and prevent further neurological damage. Surgery can be indicated for very severe pain where a person can’t function. Progressive neurological damage with weakness can indicate that surgery is necessary. Bowel/Bladder nerve involvement is a relative emergency and usually necessitates surgery.
How quickly will I recover?
The symptoms usually improve in a few weeks but pain may last up to 3 – 6 months. In some cases numbness and weakness may take longer and sometimes never fully recover.
How serious is this to my health?
Radiculopathy is not a life threatening condition and can improve over time. Cauda Equina Syndrome however, is a serious condition that happens when the nerve roots to the bowel, bladder, genitalia are compressed.
When this happens a doctor can usually detect it by examining you. A person with cauda equina can have difficulty voiding (peeing), bladder incontinence (accidents), severe constipation, or numbness/tingling/burning around the anus, penis, vagina (the “saddle region”), and erectile dysfunction in men.
If the following symptoms occur please see your GP/ emergency urgently: Progressive weakness, very severe pain, “saddle symptoms”, or bowel/bladder changes.
What will surgery do?
Surgery will cut out part of the disc or bone so it is not pushing on the nerve. This is done to relieve pain in the leg, or relieve pressure from the cauda equina if it is being pinched (cauda equina syndrome). Even after successful surgery you may still be left with weakness or numbness if the nerve is already damaged.
What should I do while I’m waiting for my lumbosacral radiculopathy to get better?
- Avoid spine flexion activities (click here for instructions)
- Spine extension exercises (hyperlink)
- Nerve flossing (hyperlink)
- Epidural steroids (hyperlink)
- Pain medications
Avoid heavy lifting. We also recommend that you avoid chiropractic manipulation while a nerve is being pinched in your back causing pain. Try to avoid activities that cause pain to travel down the leg. When the pain is gone you can slowly go back to normal activities and exercise