Lumbar Radicular Syndrome
- Pain radiating into the lower extremity in a quasi-segmental but not dermatomal distribution
- Leg pain more than back pain
- 25 – 60 years old
Compression of nerve root within intervertebral foramen by tumor, HNP, vertebral body fracture or degenerative changes (e.g. stenosis through spondylophytes, spondylolysis, compression fracture)
Peripheral nociceptive pain. Local inflammatory response common. Central sensitization possible due to prolonged high levels of pain
Mild compression has a good prognosis with physiotherapy. Severe paresis requires surgical intervention with subsequent physiotherapy. Within the first 6 months, significant improvement in QoL possible.
Psychosocial factors can negatively influence the prognosis.
Usually rather lengthy course with good prognosis if patient receives proper education, shows good compliance and does not have any yellow flags
History & Physical Examination
Insignificant trauma in history (twisting, lifting); possibly recurrent or at least history of less severe low back pain episodes
- Burning pain
- High intensity (acute) or varying intensity (subacute) VAS 5-10/10
- Tingling/numbness in lower extremity up to paresis
- More leg than back pain
- Central cord compression can lead to cauda equina syndrome
Relieving posture, typical shift or slight flexion
Pain apparent in all movement directions; significant increase with additional compression of the nerve; patient can provoke pain with ease; typically during transfers or apparent during gait (limping)
PPIVMs & PPAVMs provoke pain on affected segment and segment above/below; stiffness and hypertonus of paraspinal structures; muscle length tests: Rectus femoris, glutei, iliopsoas…; in acute phase impossible due to pain
- Facetjoint hypomobility
- SI-Joint dysfunction
- Spinal stenosis
Concerning cause of compression:
- Vertebral fracture
Decrease pain in acute phase. Move into pain-free directionsSubacute phase: coordination, strength, endurance, and stability of trunk.Patient education
- Treat surrounding structures and decrease compression
- Movements into pain-free direction
- Muscle relaxants/NSAIDs
- Trunk stability
- Motor control
- Education on ergonomics
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