Lumbar Radiculopathy (Sciatica)––Dr. Katharine Leppard

Lumbar Radiculopathy (Sciatica)

By Katharine Leppard, MD, Colorado Springs LIVING WELL Magazine

A lumbar radiculopathy is a pinched nerve in the low back. Typically, this causes low back and buttock pain, with pain radiating into one or both legs, which can be associated with numbness and weakness. A common lay term is sciatica. Leg pain can commonly be worse than low back pain. The pain is caused by compression of the nerves as they exit the spine.

The anatomy in the spine is beautiful and complex. The vertebrae are the bones in the spine. These are stacked on top of each other in a column. In between the bones is a structure called the disc. A spinal disc is a shock absorber pad or cushion between the bones. Between each bone, and next to the disc, a spinal nerve exits on both sides of the spine. These nerves can become pinched by a number of issues including a disc injury, by arthritic bone spurs, or a shift in the spine, which narrows the nerve canals. Central canal spinal stenosis is a narrowing of the main central canal in the spine. Typical symptoms for spinal stenosis include pain and numbness radiating into the legs with walking––commonly this improves when sitting down.

A spinal disc is built like a jelly doughnut. There is a tough outer wall called the annulus, and a watery jelly center called the nucleus. The jelly center of the disc in young people typically has a large amount of water. As we age, the jelly center of the disk dries––this is called degenerative disc disease. Any injury that compromises the outer wall of the disc––the annulus––will cause the center of the disc to dry earlier than expected. This is called degenerative disc disease. Sadly, this is not a reversible change.  I’ve seen advertisements for spinal decompression (spinal traction) where they claim that it will rehydrate a dried disc––this is not accurate. Once the outer walls of the disc are compromised, that disc cannot maintain the water inside it, and it will remain dehydrated.

Three types of injury can occur to a disc. The outer wall can tear, which is called an annular tear. The outer wall can bulge but remain intact, which is a disc bulge. The outer walls can tear and the jelly can come out of the disc, which is called a disc rupture or herniated disc. The term “slipped disc” is a misnomer, as the disc itself does not shift out of place. As we age, the spine also develops bone spurs around degenerative discs, and also in the joints of the spine called the facet joints. Age can also cause disc bulging and arthritis that combine to cause spinal stenosis.

Diagnosis of lumbar radiculopathy can be made based on history, physical examination, x-ray, MRI and EMG testing. MRI scans give the most detailed information about the cause of radiculopathy.

Treatment for radiculopathies falls into several main categories.

  1. Do nothing, often Mother Nature will resolve the problem. Please seek medical attention prior to doing nothing, there are very real risks of nerve damage and weakness if a serious condition is ignored. The longer there is pressure on a nerve, the greater the risk of permanent nerve damage. If someone develops sudden foot drop, which is weakness in raising the foot, this is a surgical emergency. They should be seen in the emergency room immediately, and typically requires surgery within 24 hours. Delay can lead to permanent foot drop.
  2. Surgery, the most extreme intervention, is done when there is significant pathology such as spinal cord compression, instability or severe nerve compression.
  3. Steroids, which reduce the swelling of a pinched nerve. These can be steroid pills or injections. Epidural injections are done into the spine under x-ray. There are potential side effects and risks of both the medication and injections. Cervical epidural injections have the remote risk of a spinal cord injury. How much steroids will help a patient is unknown.
  4. Traction, which temporarily opens the nerve canals one on the machine, temporarily relieving the pressure off the inflamed nerve, and allowing natural healing to occur. Traction and decompression are the same thing, and is covered by insurance if done through physical therapy. Traction for pinched nerves in the low back typically is not effective; traction is much more effective for a pinched nerve in the neck. Traction does not make disc protrusion smaller. The jelly center of the disc is 80% water, and through natural healing the body will reabsorb the extruded jelly of a disc rupture, and make disc ruptures smaller with time. Advertisements that show a reduction in the size of the disc herniation over time are demonstrating this natural healing––this is not an effect of traction.
  5. Hands on treatment with soft tissue work and gentle exercise to reduce muscle spasm and improve range of motion. High velocity spinal adjustments should be avoided in the presence of a truly pinched nerve. Adjustments can irritate or injure the pinched nerve, and make a small disc rupture into a large disc rupture, and can necessitate surgery.
  6. Being extremely careful with body mechanics can help to protect the disks.

Proper diagnosis is the first step towards appropriate treatment. Lumbar radiculopathies can be very painful and have the risk of permanent nerve damage if ignored. The majority of lumbar radiculopathies resolve without surgery. Please seek evaluation if you are experiencing pain, numbness or weakness.

Dr. Leppard is with Medical Rehabilitation Specialists and may be reached at 719-575-1800.