L5 syndrome results from irritation or compression of the L5 nerve root due to various causes. Pain, sensory disturbances, or paresis are the result. Rapid diagnosis followed by conservative or surgical treatment is essential to avoid worsening of symptoms or subsequent damage.
What is L5 syndrome?
L5 syndrome is one of the so-called root compression syndromes. It results from irritation or damage to the L5 nerve root, which emerges from the spinal canal between the last lumbar vertebra and the first sacral vertebra. Pain, loss of sensation and, in the worst cases, paresis are the result. Together with S1 syndrome, L5 syndrome accounts for about 95 percent of all back-leg pain caused by herniated discs in the lumbar spine.
Causes
In most cases, the cause of L5 syndrome is a herniated disc. Both the protrusion of the gelatinous nucleus and its exit from the fibrous ring lead to damage or irritation of the nerve root. Benign as well as malignant tumors or space-occupying cysts can also exert pressure on the nerve root and cause the symptomatology. Another cause may be spinal canal stenosis. This arises, for example, from a narrowing of the joint space or from pathologic changes in the vertebral bodies and resulting bony prominences that protrude into the spinal canal and constrict the nerve root.
Symptoms, complaints, and signs
Whatever the underlying cause of L5 syndrome, the symptomatology always manifests in the same way. Pain occurs in the affected dermatome, that is, the area supplied by a particular nerve. In the case of the L5 nerve root, this is the area on the back of the thigh, the outer knee, and the front and side of the lower leg. The dorsum of the foot as well as the big toes are also affected. If a tumor is the cause of the symptoms, the pain occurs mainly at rest. In contrast, when the trigger is a herniated disc, pain usually occurs with exertion. An increase in pressure within the spinal canal, such as occurs when coughing or sneezing, increases the sensation of pain. Apart from pain, there may be sensory disturbances in the dermatome. If the damage is more extensive, not only the sensory but also the motor nerve fibers may be affected. In this case, not only sensory disturbances but also paralysis occur. Restriction in the hip joint as well as weakness of the foot jack severely reduce the mobility of the leg and make it difficult to have a physiological gait pattern.
Diagnosis and course of the disease
The diagnosis of L5 syndrome is first made by a history-taking interview and a neurological examination. Here, attention is paid to pain, sensitivity, motor deficits, and attenuated or absent reflexes. The symptoms are always viewed in a side-by-side comparison. X-rays or magnetic resonance imaging of the lumbar spine are performed as imaging procedures to make an accurate diagnosis. Peroneal paresis should be considered as a differential diagnosis. In this case, there is also a weakness of the foot lifter, but there is no involvement of the gluteal or hip muscles. If the cause of the nerve root compression is a herniated disc, an exact prognosis is difficult. In younger patients, acute and pain-free phases usually alternate, while older persons are more prone to chronic pain. Under medical or therapeutic treatment, symptoms usually improve within a few weeks, although recurrence cannot be ruled out. The speed of recovery depends largely on the extent of the damage and the neurological deficits. In addition, the patient’s self-motivation is an important factor in the improvement of symptoms.
Complications
In any case, L5 syndrome must be diagnosed and treated by a physician. There is usually no self-healing in the process, and the symptoms worsen over time. Patients primarily suffer from severe pain and swelling. The pinched nerves can also lead to paralysis and other sensory disturbances, so that patients are significantly restricted in their everyday lives.It is not uncommon for those affected to also be dependent on the help of other people in their daily lives and to no longer be able to perform many everyday tasks on their own. Various sensory disturbances can further restrict everyday life and significantly reduce the quality of life of those affected. Mobility is also restricted, so that most patients also suffer from movement disorders. Treatment of the syndrome usually depends on the cause. In most cases, not all symptoms can be completely limited. However, with the help of various therapies, the pain and swelling can be alleviated. The life expectancy of the affected person is usually not changed by the L5 syndrome. Furthermore, no particular complications occur during treatment.
When should you see a doctor?
Undefinable pain in the upper or lower leg indicates that L5 syndrome is present. A doctor should be seen if the pain has not subsided after a few days or even worsens as it progresses. If other symptoms or discomforts become apparent, immediate advice from a physician is needed. Affected persons who experience pain when coughing or sneezing should seek medical advice. Sensory disturbances or disturbances of sensation are also typical signs of the rare pain syndrome and must be clarified and treated quickly. The syndrome occurs mainly in connection with tumors or cysts. Spinal stenosis may also be a possible cause that must be clarified if signs of L5 syndrome become apparent. People who suffer from the described symptoms as a result of an accident or an operation are best advised to consult their family doctor within the same week. In addition, a sports physician, orthopedist or internist can be consulted. If the condition is treated quickly, long-term consequences can usually be avoided.
Treatment and therapy
Treatment is given depending on the cause. If a tumor has formed in the lumbar spine, surgery is definitely indicated. Bony prominences that protrude into the spinal canal can also be surgically removed. On the other hand, conservative treatment methods are always resorted to first in the case of a herniated disc. Medications relieve the pain and normalize the tone of the back muscles, which are often tense or cramped due to pain. Transcutaneous electrical nerve stimulation (TENS) also reduces pain by controlled relaxation of the muscles. Heat applications or massages achieve the same effect in a gentle way. However, if the herniated disc causes motor deficits, immediate surgery is inevitable to avoid consequential damage. Here, nerve root decompression is achieved by removing the damaged disc tissue. If necessary, a prosthesis can be inserted to replace the disc. As a general rule, none of the treatment measures should be continued for too long if there is no improvement. After a period of about four weeks, the pain-induced, permanent protective posture and various evasive movements cause the affected muscles to shorten and the joint capsules to shrink. This can result in a chronification of the pain and, in extreme cases, lead to deformation or instability of the lumbar spine.
Outlook and prognosis
The prognosis is significantly tied to the presenting cause as well as the stage of the disease when the diagnosis is made or when treatment begins. The sooner L5 syndrome can be diagnosed in a patient, the better the further developments. Depending on the cause, the treatment plan is developed, which may include conservative or surgical therapy. In the case of mild discomfort, relief of health discomfort is achieved through the administration of medication. In addition, training is provided to optimize movement patterns and to improve the handling of physically stressful activities. These are intended to bring about long-term recovery. If the affected person adheres to the learned exercise units in everyday life, a cure can be documented after a few weeks or months. In the case of more severe impairments, surgery is performed. This is associated with the usual risks. As with any surgery, complications can occur. In severe cases, a prosthesis is inserted.If the treatment proceeds without further disturbances, further therapeutic measures are taken in the subsequent recovery process. The muscular system is stabilized and the possibilities for movement are improved. Although relief is achieved in many patients, long-term impairment may occur. An unfavorable prognosis is given if pain becomes chronic or if deformity as well as instability cannot be corrected.
Prevention
Depending on the cause of a possible L5 syndrome, certain preventive measures can be taken. Regular and varied exercise strengthens the trunk muscles and gives the spine the necessary stability. In addition, the intervertebral discs are nourished and kept flexible by the continuous loading and unloading. Excess weight promotes herniated discs or degenerative processes of the spine and should be avoided if possible. Especially during sedentary activities, an upright or dynamic posture has a positive effect on the spine. Correct posture of the back should also be observed when lifting and carrying heavy objects in order to prevent excessive pressure on the lumbar spine. The correct execution of these movements can be learned in various courses.
Aftercare
In most cases of L5 syndrome, the measures of aftercare are very limited. In this case, affected individuals should see a doctor early and initiate treatment so that symptoms can be relieved early. If L5 syndrome is not treated, it can lead to severe complications that can significantly limit the life of the affected person. For this reason, a physician should be contacted at the first signs of L5 syndrome. Most patients are dependent on the measures of physiotherapy. It should be noted that many exercises can also be performed at home, which speeds up the treatment. Likewise, when taking medication, care should be taken to ensure that the correct dosage is taken and that it is also taken regularly. If there is any uncertainty, a doctor should always be consulted first. Most patients with L5 syndrome are dependent on the help and care of their own family, which can have a positive effect on the course of the disease. Psychological support is often necessary in order to prevent psychological complaints or depression. As a rule, L5 syndrome does not reduce the life expectancy of the affected person.
What you can do yourself
L5 syndrome can be counteracted by means of various exercises and aids. Depending on the extent of the discomfort and the present symptomatology, adequate pain therapy is recommended, which can be supplemented with sedatives from nature in consultation with the doctor. Changing risky lifestyle habits is one of the most important measures, as this is the only way to effectively prevent another incident in the long term. If the causative disc herniation causes motor deficits, immediate surgery is required. After surgery, rest and bed rest are indicated. The patient should not put any heavy load on the spine for at least two to three weeks. After that, the nerve roots can be strengthened by means of some exercises from the field of physiotherapy. In addition, the causes of the nerve complaint must be determined and, if possible, eliminated. Sometimes, for example, the complaints are caused by overweight or poor posture – triggers that can be treated by physical exercise. Physical exercise also helps with muscle tension, as do massages and alternative measures such as acupuncture or methods from Chinese medicine. If symptoms recur, a doctor must be consulted. With L5 syndrome, there is always a risk of renewed root compression, which requires further medical treatment.
