Back and leg pain: Is it sciatica or radiculopathy?
After a quick online search of symptoms, many people seeking relief for low back pain that also causes discomfort down into the glutes or leg believe they have sciatica. The sciatic nerve is a large nerve that goes down the leg, and sciatica refers to pain along this nerve. One of the most common causes of sciatica is actually a lumbar spine condition known as radiculopathy.
In my experience as a spine surgeon, radiculopathy isn’t as widely discussed as sciatica. Here are some answers to questions you may have about this type of pain.
What is radiculopathy?
Radiculopathy is a nerve root inflammation in the spinal column related to pressure on the nerve that is often caused by a bulging or herniated disc in the lower spine. As with many spine conditions, it can cause pain and impact movement, especially in the back and lower body. Left untreated, radiculopathy can become debilitating.
What are the symptoms of radiculopathy?
There are a number of nerves in the lower spine. Symptoms of radiculopathy depend on what specific nerve is being affected and how it’s impacted. If it is one of the nerves that goes on to form the sciatic nerve, it is classically pain starting in the back or the glutes and radiating down the leg.
Numbness, weakness and tingling in the leg can be symptoms of radiculopathy, and symptoms may come and go or be constant. Sciatica and radiculopathy represent overlapping conditions, with radiculopathy being the most common underlying cause of sciatica.
Sciatica can have other causes, and, depending on the nerve involved, radiculopathy can result in different leg pain (such as front of thigh), than sciatica.
How is radiculopathy treated?
The first step in finding relief usually involves conservative treatment, including observation, activity modification, physical therapy and medications. If symptoms persist, imaging studies (such as an MRI) of the lower back can help pinpoint structural areas causing radiculopathy.
Once the exact area and nerve causing radiculopathy is identified, steroid injections can also help. Together, all of these steps can help relieve the underlying inflammation.
If conservative approaches don’t relieve the discomfort, you may need to consider surgery. While conservative approaches are aimed at alleviating symptoms, the goal of surgery is to address the underlying cause of radiculopathy.
Surgery aims to take pressure off the distressed nerve and often involves spinal fusion—joining two or more spinal bones together. Here’s what you can expect if you have surgery for radiculopathy:
- Most patients stay one or two nights in the hospital.
- Pain should start to slowly go away over the course of a week or two.
- As the pain goes away, you can slowly begin normal, daily living activities and possibly return to work, depending on the nature of your job.
- It takes two or three months (or longer for more complex surgeries) for a full recovery.
It’s important to note that the vast majority of people living with radiculopathy don’t require surgery to treat their condition. An orthopedic specialist can help walk through the options and determine the best treatments for you.
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