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Condition/Disorder Synonyms


  • Herniated intervertebral disk

  • Prolapsed intervertebral disk

  • Slipped disk

  • Ruptured disk

  • Herniated nucleus pulposus


ICD-9-CM Codes


  • 724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified

  • 722.73 Intervertebral disc disorder with myelopathy lumbar region


ICD-10-CM Codes


  • M54.16 Radiculopathy, lumbar region

  • M54.17 Radiculopathy, lumbosacral region


Preferred Practice Pattern


Key Features




  • 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


Essentials of Diagnosis


  • Diagnosis made by clinical examination

  • Dermatome/myotome pattern

  • Reproduction of symptoms


General Considerations


  • Herniated disk is one cause of radiculopathy

  • Avoid positions that increase symptoms




  • Women at greater risk than men

  • Onset typically middle-aged to geriatric


Clinical Findings


Signs and Symptoms2


  • 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


Functional Implications


  • 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


Possible Contributing Causes


  • 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


Differential Diagnosis


  • 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


Means of Confirmation or Diagnosis




  • 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


Findings and Interpretation


  • 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)




  • To hospital for imaging


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