Acute lumbosacral radiculopathy: Pathophysiology, clinical features, and diagnosis
- Philip S Hsu, MD
Philip S Hsu, MD
- Assistant Professor
- Tufts University School of Medicine
- Carmel Armon, MD, MHS
Carmel Armon, MD, MHS
- Chairman, Department of Neurology
- Assaf Harofeh Medical Center
- Associate Clinical Professor of Neurology
- Tel Aviv University Sackler School of Medicine
- Kerry Levin, MD
Kerry Levin, MD
- Chairman, Department of Neurology
- Cleveland Clinic
- Cleveland Clinic Lerner College of Medicine
Lumbosacral radiculopathy is a condition in which a disease process affects the function of one or more lumbosacral nerve roots . The clinical aspects of lumbosacral radiculopathy will be reviewed here.
The treatment of lumbosacral radiculopathy and other disorders of the lower spine are discussed separately. (See "Acute lumbosacral radiculopathy: Treatment and prognosis" and "Lumbar spinal stenosis: Pathophysiology, clinical features, and diagnosis" and "Evaluation of low back pain in adults" and "Subacute and chronic low back pain: Pharmacologic and noninterventional treatment" and "Subacute and chronic low back pain: Nonsurgical interventional treatment" and "Subacute and chronic low back pain: Surgical treatment".)
The lumbar spine consists of five movable lumbar vertebral bodies, numbered L1 to L5 (figure 1). The sacrum is made up of five developmentally fused vertebral levels (S1 to S5), followed by a terminal bony prominence, the coccyx. The entire region is commonly described as the lumbosacral spine.
Directly beneath each lumbar and sacral vertebra, there is a pair of neural foramina with the same number designation, such that the L1 neural foramina are located just below the L1 vertebral body. Neural foramina are bounded superiorly and inferiorly by pedicles, anteriorly by the intervertebral disc and vertebral body, and posteriorly by facet joints (figure 1).
Through each neural foramen passes the same numbered spinal nerve root, recurrent meningeal nerves, and radicular blood vessels. On each side there are five lumbar, five sacral, and one coccygeal spinal nerve roots.
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- Myotomes and dermatomes
- Sinuvertebral nerves
- PATHOPHYSIOLOGY AND ETIOLOGY
- Pain generators in the lumbosacral spine
- Degenerative changes
- Disc protrusion and level of injury
- Other skeletal causes
- Nonskeletal causes
- Fiber size
- CLINICAL PRESENTATIONS
- L1 radiculopathy
- L2/L3/L4 radiculopathy
- L5 radiculopathy
- S1 radiculopathy
- S2/S3/S4 radiculopathy
- EVALUATION AND DIAGNOSIS
- Physical examination
- - Maneuvers
- - Nerve conduction studies and electromyography
- - Somatosensory evoked potentials
- Cerebrospinal fluid analysis
- DIFFERENTIAL DIAGNOSIS
- Low back pain
- Spinal stenosis
- Cauda equina syndrome
- Diabetic amyotrophy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS