A Review of Lumbar Radiculopathy, Diagnosis, and Treatment

Abstract

We review the epidemiology, etiology, symptomatology, clinical presentation, anatomy, pathophysiology, workup, diagnosis, non-surgical and surgical management, postoperative care, outcomes, long-term management, and morbidity of lumbar radiculopathy. We review when outpatient conservative management is appropriate and "red flag" warning symptoms that would necessitate an emergency evaluation. Diagnostic modalities, including magnetic resonance imaging (MRI), computerized tomography (CT), contrast myelogram, electromyogram (EMG), and nerve conduction velocity (NCV), are involved in the diagnosis and decision-making are discussed. Treatment of lumbar radiculopathy requires a multimodal and multispecialty team. We review indications for the involvement of other professionals, including physical therapy (PT), occupational therapy (OT), physical and rehabilitation medicine (PMR), and pain management.

Keywords: lumbar radiculopathy; lumbar spine; spine neurosurgery.

Figure 1. Dermatomes

Anatomical map of the sensory dermatomes of the Lumbosacraloccygeal region Image provided by the National University of Córdoba with permission for use.

Figure 2. A. T2 sagittal MRI of the lumbar spine w/o contrast B. Axial MRI of the lumbar spine w/o contrast

A. Sagittal T2 w/o contrast MRI lumbar spine shows a large 9 mm L5/S1 paracentral disc protrusion with mass effect on the thecal sac. B. Axial T2 w/o contrast MRI lumbar spine; the same patient shows compression of the right exiting S1 nerve root, which has caused this patient to experience right S1 radiculopathy.