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Condition/Disorder Synonyms

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  • Herniated intervertebral disk

  • Prolapsed intervertebral disk

  • Slipped disk

  • Ruptured disk

  • Herniated nucleus pulposus

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ICD-9-CM Codes

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  • 724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified

  • 722.73 Intervertebral disc disorder with myelopathy lumbar region

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ICD-10-CM Codes

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  • M54.16 Radiculopathy, lumbar region

  • M54.17 Radiculopathy, lumbosacral region

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Preferred Practice Pattern

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Key Features

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Description

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  • Any disorder that affects the spinal nerve roots

  • Lateral lumbar spine nerve-root compression

  • Gradual or acute onset secondary to intervertebral disc or osteophyte formation in the intervertebral foramen2

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Essentials of Diagnosis

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  • Diagnosis made by clinical examination

  • Dermatome/myotome pattern

  • Reproduction of symptoms

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General Considerations

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  • Herniated disk is one cause of radiculopathy

  • Avoid positions that increase symptoms

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Demographics

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  • Women at greater risk than men

  • Onset typically middle-aged to geriatric

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Clinical Findings

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Signs and Symptoms2

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  • Pain in lumbar, hip, buttock, leg, lower extremity; parasthesia often radiating into the foot

  • Pain in lumbar spine worsens with extension, side bending, rotation to the involved side

  • Diminished sensation, motor control, and reflexes in the distribution of involved nerve

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Functional Implications

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  • Difficulty maintaining sitting postures secondary to back and leg pain

  • Inability to sleep

  • Weakness with lifting, prolonged standing

  • Loss of movement or feeling in the lower extremity

  • Loss of bowel and bladder control

  • Difficulty with movements (driving, twisting) secondary to pain

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Possible Contributing Causes

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  • Decreased lumbar lordosis posture due to tight hamstrings, weak abdominal muscles

  • Prolonged side-bending position towards impaired nerve or prolonged flexion

  • Facet hypertrophy

  • Size of spinal canal, may be congenital

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Differential Diagnosis

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  • Peripheral nerve impairment

  • Piriformis syndrome

  • Hip pathology with radiating pain pattern

  • Spinal tumor

  • Lyme disease

  • Peripheral neuropathy

  • Sciatica

  • Paraspinal spasms

  • Degenerative disk disease

  • Sacral or pelvic dysfunction

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Means of Confirmation or Diagnosis

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Imaging

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  • MRI helps to visualize compressed or inflamed nerve root in diagnosis

  • X-ray/plain-film radiograph helpful if osteophyte located in intervertebral foramen

  • CT to show herniation compressing the spinal canal or nerves

  • Electrodiagnostic/nerve conduction testing can help determine specific impaired nerve function4

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Findings and Interpretation

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  • Physical examination to rule in lumbar radiculopathy

    • Algorithm for examination of the lumbar spine

    • Quadrant test

    • FABER test

    • Rotation limited to ipsilateral side

    • Straight leg raise test

    • Slump test

    • Lower limb nerve tension test

    • Patella, Achilles, hamstring reflexes

    • Radicular pattern

    • Passive physiological intervertebral mobility testing (PPIVM)

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Referrals/Admittance

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  • To hospital for imaging

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