2021 Mar 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
Acute lumbosacral radiculopathy is a diffuse disease process that affects more than one underlying nerve root, causing pain, loss of sensation, and motor function depending on severity. Muscle strength is often preserved in the case of radiculopathy because muscles often receive innervation from multiple roots. Thus, muscle strength is often only affected by severe cases of radiculopathy. Lumbosacral radiculopathy is very common. Most cases of lumbosacral radiculopathy are self-limited. The most common symptom in radiculopathy is paresthesia. Another common presentation is back pain radiating into the foot, with a positive straight leg raising test.
The most common cause of lumbar radiculopathy is a herniated disc with resultant nerve root compression. This process can be acute or can develop chronically over time. Imaging is not always a helpful diagnostic modality as almost 27% of patients without back pain have been found to have disc herniation on magnetic resonance imaging (MRI). Furthermore, this incidental finding does not appear to be predictive of future development of back pain.
To diagnose a herniated disc as a source of a patient's pain, it is important to review the complete history and physical and making sure that the symptoms match the imaging results. Patients with lumbar radicular pain often respond to conservative management. Patients who do not respond to conservative therapies will likely need an MRI for further evaluation. Referral from the primary team to a specialist for alternative therapies such as an epidural steroid injection should be considered, depending on the severity of symptoms.