Lumbar Radiculopathy ("Sciatica"): What you need to know.
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- Опубликовано: 8 окт 2022
- "Lumbar Radiculopathy" (sometimes referred to as 'sciatica') is a common cause of low-back pain associated with radiating symptoms into the leg. We will discuss the most important facts about this condition, including diagnosis and treatment.
www.MustafaKhanMD.com
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This is the best video I’ve seen on the basics of this condition. Thanks.
That is very kind of you, appreciate your wonderful comment. Thank you!
Thanks so much. Your explanations are detailed and yet simple to understand. I'm beginning treatment and feel very armed to understand my options and causes
Very kind of you, thank you for watching.
Also, this video may be helpful to you:
ruclips.net/video/ovSTtD08Olw/видео.html
Good luck! 👍
I’m getting a discectomy next week. I’ve had tremendous pain for 8 months. It’s taken this long for surgery to happen and I am very hopeful as you say most people are successful and happy…
Thank you for reaching out: Wishing you all the best in your upcoming surgery.
I have the following two videos regarding this condition, which may be of interest to you:
What does a herniated disk look like:
ruclips.net/video/_Y-YlD7ZHHU/видео.html
Microdiskectomy surgery: Step-by-step:
ruclips.net/video/tFivqHEVIgg/видео.html
You are extremely helpful in helping me understand my back pain. Much appreciated!
Thank you for your kind words, I appreciate it. Glad to be of help!
suffering from lumbar radiculopathy and undergoing Pain management for 4 weeks now. Inexplicable pain and watching this video makes me think that I have S1 base on how you describe the pain from each nerve. Thank you so much Doctor. Very informative. I really appreciate this kind of videos. Keep it up.
Thank you for your kind words, happy I could be of help. Good luck! 👍
Have you feel better i also have really bad cramping nd shooting in my feet i dont know where it comes frome but please i feel helpless what you think what i can do to get better 😢 hoping to hear frome you back 🙏
He is so smart and very kind❤ and he explained things to me in away that i could understand.
loving great knowledge
Thank you for watching!
Excellent presentation.
Thank you for your compliment.
A very clear and informative video. Thank you.
Thank you for your kind words, appreciate it 🙏
Wow, excellent presentation ! Thank you very much dear ,
Thank you for watching, appreciate your kind words.
Wow. Excellent presentation. I know I will be referring back to this video.
Thank you for your compliment, very much appreciated!
Iv'e been suffering from low back pain for several years but had always resolved itself after a few days or weeks of therapy and generally taking it easy. It has gotten significantly worse since July of 2022 when I eventually got the steroid injections which helped for 3-4 months and then things started to gradually get worse and I tried the injections again last August with no effect. Started seeing a pain management specialist who diagnosed me with Lumbar Ridiculothopy, Vertebrogenic pain syndrome, Arthropathy of lumbar facet joints and chronic pain syndrome. Tried another round of injections this time interlaminar vs transforaminal also with no effect. Had the Intracept procedure done on L3 and L4 which significantly helped with the axial pain but of course no effect on the Ridiculothopy pain. I have near constant severe pain in my buttocks, top and outer side of quads and into my calves, initially mostly in the right side but now also increasing in the left leg. MRI results, severe degenerative disc disease at L3-4 as evidenced by disc dessication, loss of disc height, endplate irregularity, and osteophyte formation. Prominent schmorls node along endplate of L4. Disc dessication throughout the remainder of the lumbar spine. At L2-3 there is disc bulging superimposed upon facet and ligamentous hypertrophy. Bilateral lateral recess narrowing with encroachment upon both L3 nerves. Mild bilateral foraminal narrowing is seen. At L3-4 facet and ligamentous hypertrophy superimposed upon disc bulging. There is narrowing of the lateral recesses. Severe bilateral neural foraminal narrowing with mass effect upon the exiting L3 nerves, bilaterally. At L4-5 prominent facet hypertrophy and ligamentous hypertrophy superimposed upon disc bulging. Bilateral lateral recess narrowing with encroachment upon both L5 nerves. Severe bilateral neural foraminal narrowing with mass effect upon the exiting L4 nerves, bilaterally. L5-S1 disc bulging with facet hypertrophy. Moderate left and mild to moderate right foraminal narrowing are seen. Pain specialist recommends a visit with a spine surgeon to look into further options such as decompression surgery. I have an appt in 2 weeks. Iv'e been and stlll trying to be a very active and healthy 67 year old man. Been going to the gym daily for years and enjoy an active lifestyle. Opioid pain meds are the only thing allowing me to continue being active. Been through PT and chiropractic care to no avail. This latest round of severe back pain has come on rapidly and is unrelenting. Do you agree that some sort of surgical procedure would be warranted based on my MRI results and history?
Thank you for reaching out. Since each case is unique, a physical examination & image-review would be required to answer your question. I recommend getting an in-person evaluation from a spine surgeon. If you are not satisfied with the surgeon's recommendation, getting a second opinion from another surgeon in your area would be the next best thing. Good luck.
In 2001, when I was about 39 yrs old I had bilateral Sacroiliac Joint fixation (with screw and washers) and it literally gave my life back because I hadn't been able to walk for 2 years!
SI Joint fixation is not for everyone so make sure you talk to a surgeon who is VERY familiar with and has performed many of those procedures! There is another procedure that's similar to it but bone grafted from the hip joint in order to fuse the SI joints. From what I have seen and read about it is a long, very painful procedure and recovery that I wouldn't wish on anyone, and given the fact that the outcomes will be the same in the end, fusion, if I how to choose I would opt for the screws to be put in, because I was up walking on the same day! If you opt for the fusion procedure using bone grafted from your hip joint then you are in for a long, painful recovery!!
Like I said, I hadn't been able to walk for 2 years prior to surgery, but my procedure was done around 9:30 or 10 a.m., and as soon as the epidural wore off, and the nurses felt I was steady enough on my feet, I walked out of the hospital at 4 p.m. that day. Only 3 weeks after surgery I was riding as a passenger on an ATV in the mountains!!
I hope this info helps you😊
Good luck with everything❤
Something else I might add. I would never go to a chiropractor again if I were you. A chiropractor is responsible for rupturing two discs in my neck and causing the problems with my SI joints. When they tell you to twist one of your shoulders towards one direction and the opposite side hip in another direction and they suddenly press down hard on the shoulder and the hip in the different directions and that causes a cracking sound in your spine and hips they are doing a lot of damage!
Before and after I had bilateral SI joint fixation I spent a lot of time in pool therapy. You'll be surprised how much walking in warm water will help strengthen your back and legs while at the same time you're not putting weight on the parts that hurt😊
I've had problems with my spine almost my entire life. I ended up in pain management at age of 32 where they would do constant steroid injections in my spine. By the time I was 37 I had severe osteoporosis of the spine and hips because of all the steroid injections that I had been given. In addition to spinal injections I had been given Decadron shots every 3 or 4 months for inflammation, and I lost count of how many prescriptions I was given for steroids to take it home. Just be careful with steroid use because it will deteriorate your bones quickly.
Take at least 5,000 IU a day of vitamin D daily, or take the K2 + D3 combo, to help your body absorb calcium.
Best presentation I have seen, very informative and shows everything in lamens terms,
That is very kind of you, appreciate it. Thank you for watching!
Thank you so much sir it's very useful ND informative
Thank you for your kind words, I appreciate it. Glad to be of help 👍
Thank you so much sir best vidoe
Thank you for your kind words, much appreciated.
Thank you for the detailed description of lumbar nerve issues.
Could you speak on synovial cysts pressing on a nerve from arthritis in the lumbar area of the spine?
Thank you for reaching out. Synovial cysts are an interesting subset of cases; at some point I think I will make a video about it. Stay tuned!
Much gratitude Dr. for answering questions I had for the specialist who was quite quick with my appointment after saying I may need surgery. Blessings to you!
Thank you for your kind words. I am glad that I could be of assistance.
For patients who are considering spine surgery, I recommend that they watch the following video:
(Don't have spine surgery if...) ruclips.net/video/ovSTtD08Olw/видео.html
Wishing you all the best 👍
Thank you Sir
Very kind of you, thank you for watching.
Jzkh for information 😊
Thank you for your compliment, appreciate it.
Super sir
Thank you!
A lot of information, thank you. I had a server back injury many years ago and suffer with lower back pain, 24/7. Pain from 4-9. I also suffer from Lt leg thigh numbness, pain, burning and intermittent weakness. To add to that is intermittent testicle pain. Now, the last several years I experience cervical pain, numbness and headaches. You said MRI is a way to test where my issue is located and I had that many years ago, plus CT scans. Which test is better to reestablish a paper trail with details.
Thank you for reaching out. I think the best course of action would be to get an in-person evaluation with a spine surgeon (ortho-spine or neurosurgery) who most likely will order an MRI. Usually an MRI is the first-line diagnostic imaging study. Occasionally a CT scan may also provide additional helpful information, if needed. Wishing you all the best .👍
How often have you requested a weight bearing mri to be performed because the typical lay flat mri didn't show a abnormalitity such as a disc bulge or herniation as a result of a abnormal straight leg test or EMG findings? Studies indicate that typical lay flat mri's can miss 30% of spinal injuries, because the back is at rest and not under compression or load.
Based on my EMG findings I have issues stemming from L3 to S1 and conservative treatments have not worked to control the pain, numbness, weakness in the foot. Recently developed a sensation that my feet and calves are on fire that occurs when laying on back or sitting.
Unsure how anyone gets a diagnosis because I have heard so many different terms from different physicians over the years. Kinda hard to treat for something if no one agreeds on what you actually have!
That's a good question.
It is true that weight-bearing MRIs can provide additional information to the surgeon compared to conventional MRIs. However, in general practice it is an under-utilized tool. I am not sure what the reason for this is, frankly. Sometimes a technology needs to be adopted by a critical-mass of individuals before it can break-through and be accepted by the general population.
I have mild numbness, weakness, and tingling with absolutely NO pain in my right, lower leg and foot. Occasionally, I get a very small and quick tinge of pain in my lower back. I’m wondering if this is lumbar radiculopathy. I’m 47 and used to have a lot of low back pain from about age 25-30, after moving furniture, which mysteriously resolved.
Recent EMG/NCV tests, according to my neurologist, does show neuropathy. He never mentioned lumbar radiculopathy as a cause. Instead, I was given MRI’s of brain, cervical, and thoracic to check for MS, and also a comprehensive neuropathies genetic test. That showed I was a carrier for SMA due to pathogenic variant. No MS lesions we’re found on MRI, but they were done without contrast. I do also have similar symptoms in my hands and forearms. Again, mostly right side.
Thank you for sharing. The correct diagnosis can only be made after a careful, thoughtful, diligent analysis of the available data. Other pathologies can sometimes mimic lumbar radiculopathy.
@@SpineSurgeonSpeaks thank you
Hi Dr. Kahn, Excellent video. Retired PT here. I have left sided radiculopathy and have been the lucky recipient of 3 Lumbar fusion procedures...L3-4, L4-5, L5-S1. Gradually the fusions have eliminated various pain locations and intensities. I am now left with buttock pain extending distally and medially to the ishial tuberosity proceeding laterally to the ITB. area. I am scheduled for another MRI soon. My question is how often do you see symptoms that my be originating from a higher level than normal in lumbar spine?
Thanks in advance for any insight.
Thank you for your quick response. MRI is now ordered. I understand the stress transfer you mention. Last question, I know that Brand Name procedures exist. In your opinion, what is the best way to stabilize the si jt.?
I do not perform SI-joint stabilization surgery. Most such surgeries/ procedures are performed by Pain-Management physicians. I suggest a formal consultation with a PM-specialist to get specific answers.
Hello doctor, I am getting claval spine surgery next week to remove the desk on C5 C6 through the neck at Pennsylvania Hospital. I just would like to know what would be better the cage or the plate that would be stronger to hold because I have multiple disc and and a Curvature of the spine
Thank you for watching.
I made a short about pros/cons of a cage vs. bone-graft in ACDF surgery which may be helpful to you:
ruclips.net/user/shorts12iVzKYKci8?feature=share
I have the following two videos about ACDF and cervical radiculopathy which may also be helpful:
ruclips.net/video/Hml_6kM4fY8/видео.html
ruclips.net/video/5HPlzxWN2dk/видео.html
Good luck to you 👍
My mother has the same issue please find below the MRI report and please advise
History: Backache.
Comparison: None
Findings:
Termination: The cord terminates at L1.
Lumbar spinal cord / conus: Normal size, signal and configuration.
Osseous structures: Mild anterolisthesis of L5 over S1 due to spondylolysis. No vertebral compression or
marrow edema seen.
Disc spaces, Facet joints & Stenoses:
L1/2 and L2/3, no significant degeneration or disc herniation seen.
At L3/4, minimal disc bugle seen.
At L4/5, disc desiccation, preserved disc height. Tiny central annular fissure.
At L5/S1, mild anterolisthesis of L5 over S1 due to spondylolysis. Diffuse uncovering of the disc and facet
arthropathy causing moderate lateral recess / foraminal stenoses.
Pre and paravertebral space: No mass or collection.
Spondylodiskitis: No evidence seen.
Cauda Equina: Normal.
IMPRESSION: At L5/S1, mild anterolisthesis of L5 over S1 due to spondylolysis. Diffuse uncovering of the disc
and facet arthropathy causing moderate lateral recess / foraminal stenoses.
SUGGESTION: Correlation with clinical assessment, lab investigations and previous imaging are suggested.
The study can be reviewed in case of further clinical queries.
Age/Sex :
58 (Y) / F
Thank you for reaching out.
Without a physical examination, it is really not possible to offer treatment recommendations to a patient. The reason is that two patients with near-identical MRIs can have different complaints/ symptoms, and therefore may need different treatments. However, based on the limited information you shared, as a first step it would be reasonable to schedule an in-person consultation with a pain-management specialist (usually an anesthesiologist) to see if any non-surgical treatments may be beneficial. Later on, you may consult a spine-surgeon/ neurosurgeon if non-surgical treatment does not help.
Wishing you the best.
-MK
Dr, The presentation was very nice. What will bevthe L1 to L5 the diameter of the spinal canal for a person with no pain of above 60 years versus a person above 60 yesrd with sciatica
Thank you for your kind words.
Below is a paper which discusses this topic:
www.ncbi.nlm.nih.gov/pmc/articles/PMC4501532/
Dr Thanks for your clarification
Why after my Sacrolatic joint injection does the pain move all around my hips,groun,very aggressive faint when it went into my stomach its really scary i know about Radiating pain is that what this is, or is something else going on because of the injection, the injection did not take my pain away at all im waiting on a EMG
Dr what are the latest physical therapy exercises you recommend for sciatica.
Thank you for reaching out.
PT exercises can be very helpful, and the best thing to do would be to consult a therapist for your specific condition (since each patient's condition is slightly different).
However, the following simple exercise may be helpful to you:
ruclips.net/user/shortsqdASBbey0lU
Good luck.
Dr Thanks for your clarification
I think im going through this right now. Actually for years. I have an MRI scheduled later this month. When its bad i can barely move. Lots of ibuprofen. I feel it in my lower back above my buttocks and it radiates down my right leg.
I hope you get an evaluation by a spine-specialist (orthopedic spine surgeon or a neurosurgeon) to get the help you need. Good luck.
@@SpineSurgeonSpeaks Thankyou. I saw a neurosurgeon a few weeks ago after the MRI. Said I have two small bulges and some lateral and foraminal stenosis in L5. I've been doing physical therapy since. Not sure if it's working.
I have just had my 4th spinal surgery l5 s1 microdiscectomy, hoping for it to work this time!
Wishing you the best 👍
Thank you 🙏
Anything more than 2 is a waste, and risks more scar tissue that will cause bigger problems! Go to Germany and get disc replacement with lp-esp, I did!
It’s not working I have the same symptoms, I have to have an mri tomorrow and I have to go straight to the acute suite.
how does sciatica compare/contrast to SI joint pain?
That is a very good question. SI joint pain is *usually* (but not always) confined to the buttock. Sciatica *usually* (but not always) is in a radicular pattern. These conditions can often be confused with each other if the diagnostician is not careful. I should make a video about this...
I'd watch that video to, it would be greatly appreciated. The ER doc that looked at my hip pain ( left mid upper buttocks) and just said sciatica with no form of diagnosing. It didn't radiate. Almost a year later the hip still hurts, not nearly as bad, as does my lumbar and tip of my tailbone. Currently under care from a pain specialist.
17 months now and I don’t know what to do. The injections made it worse. Acupuncture made it worse. Chiropractic care seems to be helping a little bit. Tired of taking meds.
That is too long to be dealing with this problem, I agree. Have you been evaluated by a spine-surgeon/ neurosurgeon? That may be the next reasonable step for you. Good luck 👍
lumbar radiculopathy can consider as chronic arthritis?
Arthritis is different from radiculopathy. Arthritis is wear-and-tear of the joints.
So i had microdiscectomy and im still waiting on numbess to resolve. My question is why do i have bilateral symptoms if i only have s1 nerve root compression right side only?? Mild thecal sacc compression?? No one seems to be able to tell me?? Im 1 month post op.
Thank you for reaching out.
Since I don't have the specific information regarding your particular case, I am unable to give you a diagnosis or suggest an appropriate treatment.
However:
After a micro-diskectomy the nerve pain usually improves (relatively) quickly. However it is very common for the numbness to linger for a long time and it may improve much more slowly; ultimately some of the numbness may even be permanent.
As for the bilateral symptoms, it is important to remember that the MRI is done in a static position (with the patient lying down). However, the disc is dynamic--meaning that its shape/ configuration changes depending on the posture/ movement of the patient. Therefore, it is possible that the L5/S1 disc *may* be intermittently compressing the other side from time-to-time, causing some unusual numbness.
I have two videos about disc-herniation/ micro-diskectomy that may be of help to you:
ruclips.net/video/_Y-YlD7ZHHU/видео.html
ruclips.net/video/tFivqHEVIgg/видео.html
Good luck! 👍
-MK
@SpineSurgeonSpeaks Thanks for your response. I really appreciate it. My surgeon told me to give it 3-6 months, and he thought the numbness would improve. As you know, it is very frustrating. I appreciate the explanation. It is discouraging at times to still be symptomatic. I feel I waited too long and thought I could beat it with physical therapy. Have a good weekend.
My father is facing back pain and is not able to walk properly wbere he using stick or support to get up and walk. Doctor's diagnosed lumber radiculopathy. What are some treatments that can be done.... he can push and pull his toes and bend his knees
Thank you for reaching out.
Since I have not examined your father, I am unfortunately unable to offer specific medical advice. But in general patients with lumbar radiculopathy can benefit from epidural steroid injections and physical therapy. Certain medications (anti-inflammatories and muscle relaxers) can also provide additional relief. The first step is to consult a spine-specialist and to get an MRI.
Good luck!
Is it common to have Radiculopathy in both legs?
Yes. If the nerve is pinched on one side, the radiculopathy will affect one side only. On the other hand, if the nerves are pinched on both sides, both legs will be affected.
@@SpineSurgeonSpeaks Thank you for your quick reply!
Is it true that after 3 years a lumbar radiculopaty can't be due to an herniated disk itself ? In my case symptoms are not always in the same location or intensity .
Over a period of time (may take a few years), a herniated disc will (generally) be gradually broken down by the body, so the radicular symptoms will generally improve. However, it is possible if the nerve is compressed for a long-enough period, the nerve itself may become permanently damaged. So the answer to your question is not a simple yes vs. no. The reality is more nuanced than that.
@@SpineSurgeonSpeaks Thank you for your response :) . Just another question , if i feel more sensitive symptoms than motor ones , the nerve is suffering too , right ?.
I'm very afraid of surgery, i live in a little town in Argentina and here medical care is a big problem :(
A pinched nerve can cause both motor and sensory symptoms, yes. It sounds like you need to get an evaluation from a spine-specialist to guide your treatment. That doesn't mean that you will necessarily need surgery. Good luck!
Hello Sir my mother is 70 and she have DVT In left leg and vertebral column compression in D12 , doctor advised for vertebroplasty, she have numbness in left leg where she have DVT, i took second opinion from another doctor he said to take rest for two months but pain is more and she can't move her leg, please advise what to do, can vertebroplasty helps and she can walk? thanks please advise sir i am from India, pain specialist anesthesiologist already gave Epidrual injection in her spine but still it is paining
Sorry to hear about your difficult situation, it can't be easy. Unfortunately, without examining the patient and reviewing the imaging studies it is not possible to make accurate recommendations about treatment. I would consult with a spine-specialist and follow their recommendations if you think they are reasonable. Good luck and best wishes to you and your mother.
@@SpineSurgeonSpeaks thank you sir i will contact spine specialist as you suggested
If you like this video, please check out this video about Minimally-Invasive Lumbar Fusion Surgery: ruclips.net/video/9hEEb58diq4/видео.html
My grandmother has lumbar radiculopathy due to an incident that happend in our house she is 80 years old i dont understand how to treat this because she cant have a surgery what should i do sir please suggest me any appropriate solution i cant see her in pain she is suffering with pain when i am lifting her up to sit from her sleeping position while she is sleeping it is fine she is having pain killers every day so that she can withstand the pain
Sorry to hear about your difficult problem. I think it would be reasonable to consult an anesthesiologist (specializing in Pain-Management) who may be able to offer a lumbar spine injection (known as an 'epidural injection'), which can often provide meaningful relief. Best wishes!
What about L1 and L2 pain path?
L1 & L2 nerve pain usually is in the groin/ upper-thigh.
@@SpineSurgeonSpeaks thank you!
I’ve been suffering from lower back pain and sciatica for over 2 months now& It only seems like things are getting worse.
At first I was all pins and needles in my legs (worse in my left) and now I have like this pulling/tugging sensation at my toes. When it gets really bad my left foot feels so sensitive to touch putting on socks feels like sandpaper. And the shooting pains are the worst.
I’ve pretty much been bed ridden since this all started. I got an MRI and I think they misread it or something because they said I have a small 2mm herniated disc at L5S1. 2 months later and I’m just in more pain.
Is it possible for my pelvis or on of my vertebrae be dislocated? I can feel some bone on the right side of my lower back that’s totally out of place yet the doctors keep saying I’m fine it’s normal. I definitely don’t feel normal.
Any advice is much appreciated!
You have the option of getting a second opinion from another spine surgeon who can re-assess the situation from a fresh perspective. Sometimes getting another perspective can be very helpful.
@@SpineSurgeonSpeaks thank you Dr!
Hello doctor, I have burning feeling to my both legs and sometime weakness. My MRI results shows as following "L4-5: Disc bulge, mild facet and ligamentum flavum hypertrophy do not significantly narrow the spinal canal or neural foramina" and "L5-S1: Minimal disc bulge and mild facet hypertrophy. No spinal canal or neural foraminal narrowing" Based on My MRI results, can those reason cause me pain and feeling burn on my 2 legs? Thank you.
What causes this Doctor
Usually long-standing degeneration of the disc and/or the joints in the back is the underlying cause. As a result, the space for the nerve gradually decreases and eventually the nerve becomes pinched, causing radiculopathy.
Good morning DOC . I am suffering from pain in my right buttock when walking and a little numbness in my right calf side when walking . When doing certain stretching my buttock gets a sharp pain .
I had done my x ray
1. Missing of lordotic curve in lumber spine ( flat back )
2. Mild sclerosis in sacroillac joint of the both sacro iliac articulations.
This pain is almost for 2½ months , currently i am going to physiotherapist .
Will this pain resolve doc .. i am a little bit worried 😢
Thank you for reaching out. Unfortunately I am unable to provide you with treatment recommendations since I have not had a chance to examine you and review your imaging studies. The best course of action for you would be to consult a pain-management specialist for an individualized treatment plan. Wishing you all the best.
@@SpineSurgeonSpeaks Ok DOC
Thank you