• Pain radiating into the lower extremity in a quasi-segmental but not dermatomal distribution
• Leg pain more than back pain

Patient Profile

• 25 – 60 years old

Pathophysiology

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

Course

Constant (acute).

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

Insignificant trauma in history (twisting, lifting); possibly recurrent or at least history of less severe low back pain episodes

• Intense
• Deep
• 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

Physical Examination

Inspection
Relieving posture, typical shift or slight flexion

Functional Assessment
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)

Passive Examination
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

Special Testing

Neurodynamics
positive

Further Testing

Differential Diagnosis

1. PEP
2. Facetjoint hypomobility
3. SI-Joint dysfunction
4. coxarthrosis
5. Spinal stenosis

Concerning cause of compression:

1. Tumor
2. Vertebral fracture
3. HNP
4. Spondylolisthesis

Strategy

Decrease pain in acute phase. Move into pain-free directionsSubacute phase: coordination, strength, endurance, and stability of trunk.Patient education

Interventions

Acute:

• Treat surrounding structures and decrease compression
• Traction
• Movements into pain-free direction
• Infiltration
• Muscle relaxants/NSAIDs

Subacute:

• Trunk stability
• Motor control
• Neurodynamics
• Education on ergonomics

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