Radiculopathy, lumbar

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

• 724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified
• 722.73 Intervertebral disc disorder with myelopathy lumbar region

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

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1

Description

• 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

Demographics

• Women at greater risk than men
• Onset typically middle-aged to geriatric

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

Imaging

• 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

• 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
• 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