Lumbar Radiculopathy

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Adam James, Clay McCollum, Liesbeth De Feyter

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Search Strategy

add text here related to databases searched, keywords, and search timeline

Definition/Description

Radiculopathy is not a synonym for “radicular pain” or “nerve root pain”,
but patients with radiculopathy common have nerve root pain.
Radiculopathy = the whole complex of symptoms that can rise from nerve root pathology, including anaesthesia, paresthesia, hypoesthesia, motor loss and pain.
Radicular pain and nerve root pain = specifically apply of a single symptom (pain) that can arise from one or more spinal nerve roots.[7]

Lumbar radiculopathy is a disorder of the spinal nerve root from L1 to S1.[4]

Different kinds of lumbar radiculopathy

Monoradiculopathy: one spinal nerve root is involved
Acute idiopathic polyradiculoneuropathy = Guillain-Barré Syndrome
Autoallergic reaction of the spinal nerve roots and the peripheral nerves.

Compression of the radix causes changes in the sensible (dermatome) and motorial (myotome) area of this radix. Irritation of the dorsal radix results in a sharp and burning pain with irradiation (= a higher sensation of pain that occurs in a skinarea that is bigger than the area where the stimulus is given) in the dermatome. Pressure on the ventral radix gives paresis in the muscle that belongs to that myotome.
Pay attention, there is an overlap between dermatomes and some muscles are innervated by more than one motorial radix.[7]

Clinically Relevant Anatomy

add text here relating to clinically relevant anatomy of the condition

Epidemiology /Etiology

add text here relating to the mechanism of injury and/or pathology of the condition

Characteristics/Clinical Presentation

The clinical presentation of lumbar radiculopathy will vary depending on the cause of the radiculopathy and which nerve roots are being affected. Patients will often present with pain in the lumbar region that radiates through one or both legs. This pain is often described as burning, stabbing, or shooting. For this pain to be considered radiculopathy, however, neurological signs must be present such as weakness, numbness, or reflexive changes. The following chart may be useful in identifying radiculopathy clinically.

Question	+LR (yes)	-LR(no)
Weakness?	1.2	.73
Numbness?	1.0	.94

See test diagnostics page for explanation of statistics. 

Special Tests:

Straight Leg Raise Test: 

Patient lies supine and raises the leg on the involved side with the knee extended. If pain is produced at 40 degrees or less of hip flexion, the test is positive. Symptoms can be sharpened by adding ankle dorsiflexion to the straight-leg raise. Even if the test is negative, useful information can be gained if symptoms are produced past 40 degrees of hip flexion, assuming that hamstring length is equal.

Crossed Straight Leg Raise Test:

Patient lies supine and raises the leg on the uninvolved side with the knee extended. If pain is provoked down the involved leg, the test is positive for radiculopathy, and indicates that there is likely a large space-occupying lesion (herniated nucleus pulposus). This test is useful for ruling in radiculopathy, as it is highly specific for it.

Clinical presentation for radiculopathy from each lumbar nerve root: 

File:Dermatomes.jpg

Nerve Root	Dermatomal area	Myotomal area	Reflexive changes
L1	Inguinal region	Hip flexors
L2	Anterior mid-thigh	Hip flexors
L3	Distal anterior thigh	Hip flexors and knee extensors	Diminished or absent patellar reflex
L4	Medial lower leg/foot	Knee extensors and ankle dorsiflexors	Diminished or absent patellar reflex
L5	Lateral leg/foot	Hallux extension and ankle plantar flexors	Diminished or absent achilles reflex
S1	Lateral side of foot	Ankle plantar flexors and evertors	Diminished or absent achilles reflex

• Dermatomes and myotomes aren't intended as an all-inclusive list, but rather a clinically relevant system to assist in neurological screening. See dermatomal map to the left for further clarification.

Cauda Equina Syndrome:

Although relatively rare, cauda equina syndrome is a serious condition resulting from a central prolapse of a nucleus pulposus in the lumbar region. Cauda equina syndrome will present as bowel and bladder impairments, saddle area paresthesia (S4), and possible gross limitation of all lumbar movement. This condition constitutes an immediate referral to a physician.

Differential Diagnosis

Differential diagnoses for upper lumbar radiculopathy include spondylolesthesis or an infection (diskitis, epidural abscess).

Diagnostic Procedures

add text here related to medical diagnostic procedures

Outcome Measures

add links to outcome measures here (also see Outcome Measures Database)

Examination

add text here related to physical examination and assessment

Medical Management

add text here

Physical Therapy Management

add text here

Key Research

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources

add appropriate resources here

Clinical Bottom Line

add text here

Recent Related Research (from Pubmed)

Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1lClT3-kMn79CZUZKBcYtaY7EMS7_AuIEFI2WdIltBAUjtgkA|charset=UTF-8|short|max=10: Error parsing XML for RSS

References

References will automatically be added here, see adding references tutorial.