Lumbosciatalgia: causes, symptoms, diagnosis and treatment of lumbar radiculopathy

By Cristiano Antonino On May 31, 2023

Pain in the lumbar spine, lumbosciatalgia (or lumbar radiculopathy) is the leading cause of disability worldwide (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015)

Between 58 and 84% of the world’s population may suffer from it at least once in their lifetime.

While chronic lumbosciatalgia affects 11% of women and 16% of men

The patient suffering from lumbosciatalgia experiences pain in the lower back, sometimes extending to one of the two lower limbs.

Lumbar radiculopathy is caused by compression or irritation of the sciatic nerve that originates in the lumbosacral area and ends in the foot.

The pain can then radiate from the back of the thigh to the sole of the foot, or laterally to affect the big toe.

Lumbosciatalgia: what is it?

Irritation or compression of the sciatic nerve causes sharp and often unbearable pain that extends from the back to the buttock and up to one of the lower limbs (only rarely affecting both limbs).

The perception of pain affects such a large territory since the sciatic nerve is the longest in the human body.

Also called ischial nerve, it originates at the level of the piriformis muscle (which joins the inner surface of the sacrum to the femur) and gluteus.

It descends along the thigh and, below the knee, is divided into various branches distributed between the front and back of the leg and between the back and the sole of the foot.

Lumbosciatalgia: what are the causes?

Back pain occurs when the sciatic nerve is compressed or irritated.

This condition can occur for various reasons:

Intervertebral disc herniation: it is the most common cause of lumbosciatalgia, it consists in the leakage of the nucleus pulposus from the intervertebral disc, which occupies the spinal canal and irritates the nerve endings.
Lumbosacral degenerative disc disease: pathology of the spine, occurs when an intervertebral disc weakens and dehydrates, decreasing its ability to resist stress and becoming thinner.
Lumbar stenosis: the vertebral canal narrows at the rachis-sacral level, causing alterations in the column which compresses the nerve roots.
Spondylolisthesis: pathological condition which consists in the progressive forward displacement of a vertebra with respect to the underlying one.
Heavy work activities: frequent lifting of weights and incorrect postures compromise the integrity of the lower back.
Condition of overweight and obesity.
Sports that cause continuous microtraumas capable of favoring the rupture of the intervertebral discs: hernial fragments are expelled and compress the spinal roots.
Excessively sedentary life which causes a reduction in the tone of the postural muscles of the back and abdomen.
Piriformis syndrome: The piriformis muscle compresses the sciatic nerve, usually due to a contracture or trauma.
Spinal tumors, the tumor mass irritates or compresses the sciatic nerve and changes the function of the spinal nerves.
You are more likely to suffer from low back pain
the patient in old age, since aging can cause a weakening of the spine and the onset of disc herniation,
the diabetic patient, since he can develop diabetic neuropathy and – therefore – the deterioration of peripheral nerves including the sciatic nerve,
those suffering from arthritis or spinal diseases,
who has suffered trauma to the thighs or buttocks.

Lumbosciatalgia: the symptoms

The first symptom of lumbosciatalgia is pain affecting the lower back and (at least) one lower limb.

The pain is reported to be very intense and is felt mainly when sitting, when moving the torso, when coughing or sneezing.

Each patient experiences pain in a personal way: by some it is described as a burning sensation, by others as a cramp, still others refer to a sharp and penetrating pain and there are those who perceive it as a sensation similar to electric shocks.

The symptomatology is closely linked to the level of irritation/compression of the sciatic nerve.

Typically, the pain originates in the lower back and radiates to the foot; other times it stops at the buttock level.

When the compression is very serious, in addition to being associated with pins and needles or sudden thermal disturbances, the pain is associated with muscle weakness and sphincter disorders with urinary and/or faecal incontinence.

It is essential to promptly consult a general practitioner when the symptoms worsen, when they suddenly worsen, when the condition is the result of a strong trauma and when it is difficult to control one’s bowel and bladder functions to avoid the onset of complications such as total loss of sensation in the lower limb or the ability to walk independently.

Generally, the symptoms of lumbosciatalgia resolve (or at least subside) spontaneously within 30 to 60 days.

Those with radicular dysfunction due to disc herniation see the problem resolved in about 4-6 weeks.

However, in 15% of cases the patient with lumbosciatalgia can suffer a progressive worsening of the symptoms which requires timely therapy.

Lumbosciatalgia, the diagnosis

On the advice of the general practitioner, the patient will be referred to the orthopedist or neurosurgeon who – during an initial visit – will examine the patient’s clinical history and perform an objective examination.

Once the typical signs of lumbosciatalgia have been identified, he will prescribe more in-depth tests to verify his diagnostic hypothesis:

the lumbar and lumbosacral radiography allows to determine the degree of disc degeneration, to identify spondylosis or any vertebral trauma, to verify if the vertebral curves are affected by pathological variations,
spine CT is prescribed in case of contraindications to MRI or in case there is previous spinal trauma,
the MRI of the spine identifies the presence of herniated discs, tumors or serious pathologies affecting the bones (it is the most complete examination in the case of lumbosciatalgia),
electromyography, an instrumental examination that allows to evaluate the functionality of the peripheral nervous system, necessary to confirm the state of suffering of the structures that compose it.

Lumbosciatalgia, the treatment

The treatment of lumbosciatalgia depends on the severity of the symptoms and the general conditions of the patient.

In less severe cases, with a favorable prognosis, the specialist recommends an exercise program that brings long-term benefits.

Eventually it is possible to alternate hot and cold compresses where pain is felt and to perform back stretching exercises.

In case of intense pain, the most commonly used drugs are:

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oral NSAIDs (non-steroidal anti-inflammatory drugs),
muscle relaxants,
tricyclic antidepressants or anticonvulsants which, although used to treat depression and epilepsy, have also been shown to be effective in neuropathic pain,
intravenous corticosteroids, reserved only for the most severe cases due to severe contraindications.

In combination with drugs, physiotherapy is often prescribed: by improving posture and strengthening the back muscles, it is possible to obtain great benefits.

Only in the event that conservative therapies fail, the neurosurgeon may consider surgery.

However, releasing the sciatic nerve from compression is a very delicate operation and reserved for cases of narrowing of the spinal canal on an arthritic basis or in the case of a herniated disc.

Depending on its causes, back pain can resolve itself in a few weeks or several months.

Chronic low back pain

Sometimes, back pain can become chronic.

It happens when it is caused by an extensive and progressive inflammatory state involving nerves, muscles and joints.

The causes of this condition are usually:

excessive and frequent stress on the spine, which slowly weakens until it becomes inflamed, due to heavy and repetitive movements or incorrect postures held for too long,
generalized inflammatory state, caused by the simultaneous presence of overweight, excessive consumption of refined foods, stress, alcohol and smoking,
emotional stress, which predisposes to inflammation.

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