1Vilnius City Clinical Hospital, Vilnius, Lithuania
Pain in the lower back area is one of the most frequently encountered musculoskeletal conditions experienced by patients in clinical practice. It is the main cause of disability in the developed countries. Lumbosacral radiculopathy refers to a disorder which is caused by the lumbar spinal nerve root compression or irritation, leading to lower back pain which usually extends to dermatomal pattern’s lower extremities. Main causes of lumbosacral radiculopathy include damaged intervertebral discs and degenerative spine disk conditions. Other causes include inflammation, trauma and blood vessel diseases. Damaged nerve roots and surrounding tissues are irritants which are interpreted as pain, numbness or tingling. In approximately 90% cases damaged dermatomes are L4–L5 and L5–S1, which are responsible for the majority of spinal movements. Between 13% and 31% of population suffer from lower back pain. Patients with chronic back pain account for 80%–90% of all healthcare costs. Patients with lumbosacral radiculopathy may experience an array of symptoms of a varying degree of severity, including a radiating pain in lumbar and sacral dermatomes, tingling, occasional weakness and numbness, as well as abnormalities in one’s manner of walking. It is crucial to collect a comprehensive anamnesis and conduct appropriate physical tests when diagnosing lumbosacral radiculopathy. Patients usually describe radicular pain as “lightning strikes”, which spread from buttocks to feet. Identifying red-flag symptoms is also very important. Examination must also include assessment of muscular strength, impairments of senses, deep tendon reflexes and performing of Lasègue test. For patients who have been experiencing lower back pain for less than 4 – 6 weeks without identified indications of an urgent conditions, magnetic resonance imaging (MRI) or a computerized x-ray imaging are usually not prescribed. Often it is difficult to differentiate between lumbosacral radiculopathy and peripheral neuropathy or plexopathy. In such instances a patient can be prescribed with electromyography and nerve conduction test in order to localize the injury. Prescribed treatment depends on the etiology as well as intensity of experienced symptoms. Systemic steroids are usually prescribed when a patient experiences a severe lower back pain, although there is a limited evidence of their effectiveness.
Keywords: low back pain, lumbosacral radiculopathy, red-flag symptoms, degenerative spine disease, the lumbar spinal nerve root compression.