Lumbar Radiculopathy.

Lumbar radiculopathy is pain, numbness, tingling, or weakness in the leg caused by irritation or compression of a lumbar nerve root, most often L5 or S1. The classic presentation is sharp or electrical pain radiating from the buttock down the back of the leg past the knee, often called sciatica.

The most common cause in adults aged 30-50 is a herniated lumbar disc. In adults over 60, foraminal or central stenosis from degenerative changes is more common. Other causes include spondylolisthesis, vertebral fracture, infection (discitis or epidural abscess), and tumor.

Sciatica is the clinical description of pain radiating along the sciatic nerve. Lumbar radiculopathy is the diagnosis when the cause is confirmed compression or irritation of a lumbar nerve root. Most cases of sciatica are caused by lumbar radiculopathy, but not all radiculopathy involves the sciatic distribution.

Roughly 60-90% of patients improve substantially within 6-12 weeks with non-operative care. Persistent symptoms beyond 12 weeks affect 10-30%, and a smaller subset develops chronic radicular pain. Early activity, physical therapy, and avoiding prolonged bed rest improve recovery.

Most cases are not serious and resolve with conservative care. Serious features that need urgent evaluation include progressive leg weakness, foot drop, saddle numbness, or new urinary or bowel symptoms — these may indicate cauda equina syndrome and require emergency surgery to preserve function.

MRI is not needed in the first 6 weeks of typical lumbar radiculopathy. Indications include progressive neurological deficit, suspected cauda equina syndrome, red flags for infection or malignancy, severe symptoms not responding to 6 weeks of conservative care, and pre-procedural planning for injection or surgery.

Most patients do not. Surgery is offered for cauda equina syndrome (emergency), progressive motor weakness, and severe pain that fails 6-12 weeks of optimal non-operative care. The SPORT trial showed surgery provides faster pain relief but similar 2-year outcomes compared with non-operative treatment.

Microdiscectomy is a minimally invasive operation that removes the herniated portion of a lumbar disc through a small incision under magnification. It decompresses the affected nerve root. Hospital stay is usually one night, and 80-90% report good or excellent outcomes at one year.

Epidural steroid injections produce clinically meaningful short-term pain relief in 40-70% of patients with persistent radicular pain. Effects typically last 4-12 weeks; about 25-40% have sustained benefit at one year. Injections may delay or avoid surgery in selected cases.

Cauda equina syndrome is compression of multiple nerve roots in the lumbar canal causing bilateral leg weakness, saddle anesthesia (numbness of the perineum and inner thighs), and bowel or bladder dysfunction. It is a surgical emergency requiring decompression within 24-48 hours to preserve function.

Yes, severe or prolonged compression can leave residual weakness (foot drop, quadriceps weakness) that may improve only partially after decompression. Most mild-to-moderate motor deficits recover with timely treatment; severe pre-operative weakness predicts incomplete recovery in 20-40% of cases.

Initial exercises include gentle walking and directional preference movements (often extension-biased for centralizing disc patients) guided by a physical therapist. Core stabilization, hip-flexor and hamstring stretching, and aerobic conditioning are added as pain improves. Avoid heavy unsupported lifting and combined bending-twisting until pain-free.

In disc-related radiculopathy, walking is usually helpful and recommended within tolerance. In central spinal stenosis, walking often worsens leg symptoms (neurogenic claudication) and relief comes with sitting or leaning forward. Stationary cycling is well tolerated in stenosis because it places the spine in flexion.

Opioids are not first-line and are usually unnecessary. NSAIDs, acetaminophen, neuropathic pain agents, and physical therapy provide most patients with adequate relief. Short courses of opioids (under 1 week) may be considered for severe acute pain; long-term opioids increase dependence risk without improving function.

Recurrence rates after microdiscectomy are approximately 5-10% within 2 years and 15-25% over 10 years. Risk factors include smoking, obesity, occupation requiring heavy lifting, and high body mass index. Same-level recurrence is the most common pattern and may require revision surgery.

Foot drop is weakness of ankle dorsiflexion (lifting the foot up), most often caused by L5 nerve-root compression in lumbar radiculopathy. Patients drag the toe, lift the knee high, or develop a slapping gait. Acute or progressive foot drop is a relative surgical urgency to preserve recovery potential.

Yes, but it is uncommon. Causes in adolescents include sports-related disc herniation, spondylolysis, slipped vertebral apophysis, and rarely tumor. Adolescent radiculopathy often responds to rest, physical therapy, and bracing; surgery is reserved for refractory cases or progressive deficits.

Neurogenic claudication is bilateral leg pain, heaviness, or numbness that appears with walking or standing and improves with sitting or leaning forward. It is caused by central canal stenosis. It must be distinguished from vascular claudication, which improves with rest in any position and is associated with absent peripheral pulses.

Yes. Each 5-unit increase in BMI raises lumbar disc herniation risk by approximately 25% and worsens outcomes after both conservative and surgical treatment. Weight loss of 5-10% improves pain, function, and surgical recovery in observational and intervention studies.

Yes. Hormonal ligamentous laxity, increased lumbar lordosis, and weight gain during pregnancy can precipitate or worsen radiculopathy, most often in the second and third trimesters. Symptoms usually improve postpartum. Treatment focuses on physical therapy and posture; imaging and most medications are restricted.

See a spine specialist for symptoms not improving after 4-6 weeks of conservative care, progressive neurological deficit, severe disabling pain, or red flags such as fever, weight loss, or known cancer. Emergency referral is required for cauda equina syndrome, acute foot drop, or rapidly progressing weakness.