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Home , Lumbar, Radiculopathy, Sciatica

PATIENT INFORMATION

Lumbar

A MaineHealth Member

There are many things that you can do to help your body heal and What is radiculopathy? Figure 1 prevent another injury: Lumbar radiculopathy (ra•dic•u•lop•a•thy) is when a in your lower back gets irritated. It can cause , numbness, tingling, or weakness along ■■ Modify or avoid activities which increase the pain. the back and leg. Figure 1 ■■ Change positions often or rest in positions that lessen your pain

■■ Be aware and use good posture when moving, sitting and standing Other names for lumbar radiculopathy ■ ■ ■■ Use ice or heat for comfort ■ Pinched Nerve ■ Bulging disc ■ ■ ■■ Do stretching and simple exercises in comfortable amounts ■ ■ Slipped disc ■ ■ ■■ Stop ■ Herniated disc ■ Ruptured disc ■■ Get enough sleep Lumbar radiculopathy can be caused by: ■■ Eat a healthy diet ■■ Herniated disc (also called a ruptured or bulging disc). Figure 2 ■■ Drink plenty of water to stay hydrated Lumbar Radiculopathy ■■ Bone spurs or arthritis (also called ). Figure 3

When is it important to call my health care provider? These are both common and often result from normal wear and tear. Smoking increases the wear and tear. ■■ Call your health care provider right away if you have any of the following symptoms: If you smoke, it’s important to quit. A nerve may be irritated by a particular activity (reaching, lifting), a trauma, like a car accident or fall, or no clear cause at all. ■■ Weakness that is quickly getting worse ■■ Severe numbness that is getting worse What is a herniated disc? Figure 2 ■■ Loss of control of bladder or bowels Your discs absorb shock, protect your , and help to keep you flexible. ■■ not explained by flu or known , such as a bladder infection Your discs are made of a hard outer ring and soft spongy material in the middle of the disc. When a disc weakens or is injured, the outer ring is not able to keep the spongy material in the middle of the disc. This is called a herniated disc. Herniate (her•nee•ate) means bulging or sticking out. This disc material and swelling can irritate the nerve. Herniated Disc

What is a bone spur? Figure 3 ■■ The breakdown of the disc increases stress on the bones of the spine. Sometimes the body tries to stabilize the spine by adding extra bone to the injured area. The extra bone is called a bone spur.

■■ Bone spurs are often called spondylosis (spon-di-los-is). mainemedicalpartners.org/neuroedu Bone Spur

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What is the treatment for lumbar radiculopathy? LUMBAR RADICULOPATHY DECISION GRID Most spine problems heal over time without in 6 to 12 weeks. They often respond to rest and self-care. Avoid activities that increase the pain in the leg such as bending, running, heavy lifting or strenuous activity. Rest and Time Non-Surgical Care Surgery Mild to moderate is ok, but avoid activities that make the pain unbearable. ■■ Your pain is bearable or ■■ You want to give it more time ■■ You have leg pain, weakness, Why might I improving to heal or loss of use of your leg that is choose this getting worse ■■ You can do most of your daily ■■ If you have more back pain NON-SURGICAL CARE option? activities than leg pain, Physical or ■■ You need to get back to work Your health care provider may also suggest early ■■ Injections called Epidural Steroid or manual therapy work as well sooner ■■ You want to give it more time treatments to focus on pain relief. These may include: ESI: These are injections done under X-ray. These or better than surgery to heal ■■ Non-surgical care for 6 weeks has are injections of a steroid medicine to reduce the ■■ ■■ Injections may reduce leg pain not helped Medicines (acetaminophen, ibuprofen, flexeril): ■■ You have other medical issues swelling and pain at the nerve that is being irritated. faster and speed pain relief To relieve pain, reduce muscle spasms, and that make surgery or injections ■■ Your pain is severe and not Injections are much more likely to help leg pain reduce in your back. more risky controlled with other treatment than back pain. ■■ : Education on how to keep ■■ 8 out of 10 of people may ■■ 8 out of 10 people may improve ■■ Most people (more than 8 out What are improve with time and rest with time and non-surgical of 10) will see a significant active along with exercises to help with SURGERY the success flexibility and posture, often with the help of Before considering surgery, we recommend that you as long as the pain can be care as long as the pain can be improvement in leg pain rates controlled controlled a physical therapist. try nonsurgical treatments for at least 6 weeks, as the of each ■■ Back pain above the beltline body is in its healing phase. Surgery is considered if option? ■■ Injections reduce leg pain in is not usually improved with ■■ Gentle back manipulation: May be many patients for a period of time surgery beneficial for the back pain but less helpful there is significant and worsening weakness, worsening for leg pain. This is usually done under numbness that limits activity or if pain is not controlled ■■ It may take longer for ■■ Physical therapy and injection ■■ 1-3 out of 100 people who have by nonsurgical treatments. Surgery is more helpful for What are the guidance of a doctor of osteopathy, symptoms to improve have very low risks minor complications such as an the risks? or physical therapy. leg pain than back pain. The majority of patients see infection or spinal fluid leak need ■■ If weakness and numbness get ■■ Less than 1 in 1000 people has a improvements in pain scores and in data collected by repeat surgery within 3 months worse you should contact your after an injection. MMP and Spine approximately 7 in 10 provider These may include , ■■ Other risks including reactions have their expectations met. increased pain or very rarely to anesthesia, nerve injury or nerve damage scar tissue with chronic nerve pain are rare What kinds of surgery are done for herniated discs? ■■ Some improvement is usually ■■ Conservative care may improve ■■ Surgery usually helps you recover How long seen within 6 weeks but it may pain in 6 weeks faster than non-surgical care will it take take longer to resume normal Microdiscectomy: This type of surgery is done as minimally invasive surgery. ■■ Activities may need to be ■■ However, after one year, people to resume activities With this surgery, the herniated disc is clipped and removed through a small my normal limited for 3 or more months who choose non-surgical care incision in the back. Most patients go home the same day and gradually get back activity? ■■ If damage to nerve occurs it have a similar outcome may take 3 or more months to to most activities within one month. see full recovery

■■ Time can improve the disc ■■ Epidural injections can help ■■ Surgery does not restore the disc Can this herniation and many people pain but the disc still needs to to normal so it is always possible happen fully heal. heal. Because of this, it is always for symptoms to return : With a laminotomy the surgeon removes a sliver of bone in the back of again? possible for symptoms to return the spine to make the canal for the nerve larger. Most patients go home the same day ■■ It is always possible for ■■ Up to 1 out of 10 people have symptoms to return ■■ Physical therapy can teach another herniation at the same and gradually get back to most activities within one month. exercises and movements that disc after surgery in their lifetime may decrease risk of recurrence

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