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  • Herniated intervertebral disk
  • Prolapsed intervertebral disk
  • Slipped disk
  • Ruptured disk
  • Herniated nucleus pulposus

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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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  • M54.16 Radiculopathy, lumbar region
  • M54.17 Radiculopathy, lumbosacral region

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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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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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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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  • To hospital for imaging
  • To physician for surgical consult if myelopathy suspected3
    • Fusion
    • Decompression
    • Laminectomy
    • Laser diskectomy
    • Microdisectomy
    • Percutaneous diskectomy
    • Diskectomy
    • Hemilaminectomy
  • To physician for imaging and medical consult if disease suspected
  • To physician for corticosteroid injection if condition does not improve
  • To physician for anti-inflammatory medication

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  • Restricted mobility of the upper lumbar and lower ...

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