What is lumboischialgia?
Medical professionals refer to lumboischialgia as pain that starts in the lower back and radiates to the lower extremity. Typically, the pain affects only one side, one half of the buttocks and one leg. In addition to the pain, other symptoms are possible, such as sensory disturbances.
Lumboischialgia must be distinguished from sciatica (“sciatica”): The latter results from isolated irritation of the sciatic nerve. In contrast, lumboischialgia additionally affects other nerves. These are nerves that leave the spinal cord at the level of the lumbar spine.
These so-called lumbar nerves provide with their motor parts, among other things, for hip flexion and knee extension as well as for the function of the gluteal muscles. The sensory parts of these nerves transmit touch, temperature and pain stimuli from the lower back and from the front of the legs to the central nervous system.
If a nerve root is irritated or damaged, the pain occurs in the areas supplied by the nerve root. Thus, each nerve root can be assigned specific areas of skin that it supplies. Doctors refer to these as dermatomes:
- First lumbar nerve root, L1: lower back pain radiating forward into the groin.
- L2: lower back pain radiating to the front of the thigh and passing below the groin
- L3: lower back pain radiating to the front of the thigh and extending from the top outside to the inside above the knee
- L4: lower back pain radiating to the front of the thigh and extending from the top outside diagonally across the knee to the inside of the lower leg
- L5: Pain in the lower back that travels along the outside of the thigh and radiates onto the front of the lower leg to the foot
In addition, lumboischialgia occasionally affects the muscles (myasthenia). For example, patients have problems climbing stairs or standing on the affected leg. They are often unable to stand on their toes or heels.
In addition, the physician often notes weakened or extinguished reflexes. This affects either the patellar tendon reflex, the Achilles tendon reflex or the adductor reflex.
Lumboischialgia: How can it be treated?
If neither paralysis symptoms nor incontinence occur with lumboischialgia, the doctor usually advises conservative treatment. For this purpose, he mainly prescribes pain therapy and physiotherapy. Effective pain therapy is very important to prevent the symptoms from becoming chronic.
If an infection is the cause of lumboischialgia, the doctor prescribes antibiotics (against bacteria) or antivirals (against viruses).
Acute lumboischialgia with disturbance of urinary and fecal continence is reason for emergency surgery!
Examinations and diagnosis
In a consultation with the patient, the doctor first takes the patient’s medical history. Among other things, he asks for a detailed description of the symptoms, how long they have existed and whether they have changed in the course of time.
This is followed by a physical examination. For example, the doctor checks the mobility of the joints, muscle strength and reflexes in the affected leg.
In the case of long-lasting complaints or acute severe symptoms such as paralysis or disorders of urinary and fecal continence, imaging examinations are necessary. Computer tomography (CT) and magnetic resonance imaging (MRI) are most commonly used. These methods can be used, for example, to visualize a herniated disc or vertebral fracture as the cause of lumboischialgia.
Causes and risk factors
Vertebral body fractures (due to accident or osteoporosis) or wear-related (degenerative) changes in the vertebral joints are other possible causes of lumboischialgia.
Other possible triggers include:
- Inflammations such as spondylodiscitis (inflammation of the intervertebral disc and adjacent vertebral bodies), Lyme disease or abscesses
- Kidney stones
- Spatial lesions that press on the nerves, such as ovarian cysts or abdominal aortic aneurysm
