The vertebral column, also known as the spinal column or simply spine, is a column of 26 bones in an adult body (24 vertebrae interspaced with cartilage in addition to the sacrum and coccyx). In adolescents, the column consists of 33 bones as the sacrum's five bones and the coccyx's four do not fuse together until after adolescence. The spine is further divided into regions: cervical (the neck), thoracic (upper back), lumbar (lower back), sacral, and coccygeal. In between the vertebrae are thin regions of cartilage known as intervertebral discs, which are made of a fibrous outer shell (annulus fibrosus) and a pulpy center (nucleus pulposus).
The lumbar spine, commonly referred to as the lower back, is the part of the spine that curves inwards towards the stomach. The lumbar spine connects with the thoracic spine at the top and extends down to the sacral spine, and is built for flexibility and power, enabling the body to lift, bend, and twist. The spinal cord stops at the point where the thoracic spine meets the lumbar spine and continues to branch out to form the cauda equina, which is a network of nerves that extend to the lower extremities of the body. Since the spinal cord does not run through the lumbar spine, it is rare that an injury to the lower back would result in paralysis or damage to the spinal cord.
Sometimes, people have pain in the lower back that radiates into the back of the thigh, leg, and foot. This type of pain is often caused by lumbar radiculopathy, which is medically referred to as scatica, which is an injury near the root of a spinal nerve in the lumbar spine. Scatica typically occurs due to the normal wear-and-tear of aging as well as unexpected pressure from the intervertebral discs (herniated discs). A herniated disc occurs when part of the center pushes through the outer edge of the disk and back toward the spinal canal or exiting spinal nerve root. This herniation puts pressure on the spinal nerves, resulting in pain, and numbness in one or both legs. Occasionally, weakness in the leg develops.
Common symptoms of lumbar radiculopathy are:
- Numbness or a tingling (“pins-and-needles”) feeling down the leg
- Pain the back and leg when sneezing or coughing
- Occasionally weakness in the leg
Diagnosis of lumbar radiculopathy will consist of a combination of a patient history, physical examination, and a series of tests. After discussing the medical history of the individual, the physician will examine the patient and assess for any leg weakness. The physician may order additional imaging studies such as an X-ray, CT or MRI scan to rule out other abnormalities and confirm diagnosis of scatica and which nerve is affected. A nerve function test called electromyography (EMG) may be ordered. This will measure the electrical activity in the nerves and muscles to determine the extent of the nerve injury.
Some individuals with lumbar radiculopathy improve over time without any treatment. In some patients, the pain will go away sooner than others and the symptoms might return at a later date. However, some patients develop symptoms that do not go away and might require some treatment for the pain and weakness.
Non-operative Treatment - Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling. Applying ice or heat over the painful areas with the use of a barrier (such as a towel) may soothe the pain.
Epidural Steroid Injections - Injecting the area around the spinal nerves with cortisone, a powerful anti-inflammatory medicine, might aide in decreasing pain. This is done using real-time x-ray imaging (fluoroscopy). Oral or IV sedation may be offered to keep the patient comfortable during this procedure.
Surgery - If the non-operative treatments have been exhausted and have failed to relieve symptoms, the physician may recommend operative treatment. There are a few surgical procedures for lumbar radiculopathy, but the exact procedure will depend on the location and source of pain as well as several other factors. Options must be discussed with the physician to determine the appropriate course of treatment.
Recovery will depend on the treatment option chosen by the individual as well as the physician. Each patient is unique, so the recovery process will vary based on his/her level of pain, extent of damage, and desired level of activity they would like to return to.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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