Lumboischialgia
and Carola Felchner, science journalistMareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.
More about the expertsCarola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.
More about the experts All content is checked by medical journalists.Lumboischialgia is lower back pain that typically radiates into one leg (sometimes both legs). The most common cause is a herniated disc in the lumbar spine. The symptoms and also the treatment are similar to those of sciatica ("sciatica"). Here you can read everything you need to know about the symptoms and diagnosis of lumbar sciatica, treatment and causes.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M54M51
What is lumbar sciatica?
Lumboischialgia is pain that emanates from the lower back and radiates to the lower extremities. Typically, the pain affects only one side (only one leg). In addition to the pain, other complaints are possible (abnormal sensations, etc.).
Lumboischialgia is to be differentiated from sciatica (sciatica): The latter is caused by an isolated irritation of the sciatic nerve. In contrast, lumboischialgia affects other nerves in addition to the sciatic nerve. These are nerves that leave the spinal cord at the level of the lumbar spine:
With their motor components, these lumbar nerves ensure, among other things, hip flexion and knee extension as well as the function of the gluteal muscles. The sensory parts of these nerves conduct touch, temperature and pain stimuli from the lower back and from the front of the legs into the central nervous system.
Lumboischialgia: symptoms
When a nerve root is irritated or damaged, symptoms appear in the areas served by the nerve root. In this way, certain skin areas can be assigned to each nerve root, which they supply. These are known 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 running below the groin.
- L3: Lower back pain radiating to the front of the thigh and stretching from the top outside to the inside above the knee.
- L4: Pain in the lower back that radiates to the front of the thigh and extends obliquely from above outside over the knee to the inside of the lower leg.
- L5: Pain in the lower back that runs along the outside of the thigh and radiates to the front of the lower leg and into the foot.
If numbness or other abnormal sensations occur, these also run in the dermatomes described.
Muscle weakness can also occur with lumbar sciatica. For example, those affected have problems climbing stairs or can no longer stand on one leg (the affected leg). Often they are also unable to stand on their toes or heels.
In addition, the doctor can often detect weakened or extinguished reflexes. This affects either the patellar tendon reflex, Achilles tendon reflex or adductor reflex.
Lumboischialgia: investigations
When talking to the patient, the doctor will first take the patient's medical history (anamnesis). Among other things, he has the symptoms described in detail, asks how long they have existed and whether they have changed over the course of time.
This is followed by a physical exam. For example, the doctor checks the mobility of the joints, the muscle strength and the reflexes in the affected leg.
Imaging examinations are also necessary in the case of long-term complaints or acute severe symptoms such as paralysis or disorders of urinary and stool continence. Computed tomography (CT) and magnetic resonance tomography (magnetic resonance tomography, MRT) are most frequently used. With these methods, for example, a herniated disc or vertebral fracture can be identified as the cause of lumbar sciatica.
Lumboischialgia: causes
The most common cause of lumbar sciatica is a herniated disc. The gelatinous core of the intervertebral disc breaks through the fibrous ring to the outside. He can press on a nerve root and cause the discomfort.
But also vertebral body fractures (due to accidents or osteoporosis) or wear-related (degenerative) changes in the vertebral joints can constrict the nerve roots.
Other causes of lumbar sciatica or similar complaints can be:
- Inflammations such as B. spondylodiscitis (inflammation of the intervertebral disc and the adjacent vertebral bodies), Lyme disease or abscesses
- Kidney stones
- Masses that press on the nerves such as ovarian cysts or abdominal aortic aneurysms
Lumboischialgia: Therapy
If there are no signs of paralysis or incontinence, lumboischialgia is preferably treated conservatively: the doctor usually prescribes pain therapy and physiotherapy for the patient. Effective pain therapy is very important to prevent the symptoms from becoming chronic.
If an infection is the cause of lumbar sciatica, the doctor can prescribe antibiotics (against bacteria) or antivirals (against viruses).
If conservative lumbar sciatica therapy does not provide relief or if paralysis or other neurological deficits occur, surgery is considered. Various techniques are used for this. For example, in the case of a herniated disc, the protruding nucleus of the intervertebral disc that presses on the nerve root can be removed (nucleotomy). Acute lumbar sciatica with disorder of urinary and stool continence is a reason for an emergency operation!
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