Lumbar Radiculopathy

What it is

Radiculopathy means a nerve root in your lower back is pinched or irritated, sending symptoms down the leg along that nerve’s path. When it follows the sciatic nerve, people often call it sciatica. In younger adults the usual cause is a herniated disc; in older adults it is more often bone spurs and the narrowing that comes with age.

What it feels like

The hallmark is pain that travels from the back or buttock down the leg, often past the knee and sometimes into the foot, frequently with numbness, tingling, or weakness in a specific pattern. For many people the leg symptoms are far more bothersome than the back itself. A disc-related flare can be worse with sitting, coughing, or bending.

How we diagnose it

Your story and a focused exam — including simple maneuvers that tension the nerve — usually tell me which root is involved. An MRI confirms the cause and the level. The imaging and your symptoms need to line up.

How we treat it

The encouraging news is that most disc-related radiculopathy improves on its own — roughly 8 or 9 in 10 people get better without surgery, often within several weeks. Part of the reason is that the pain comes not only from pressure on the nerve but from inflammation around it, and that inflammation can settle with time and treatment. Non-surgical care supports that recovery, and I usually want to give it a fair trial of at least six weeks:

• Staying gently active rather than resting in bed
• Anti-inflammatory or other medication for a limited time
• Physical therapy
• An epidural or transforaminal steroid injection if the pain is stubborn, which calms the inflammation around the nerve

If disabling leg pain persists past a fair trial — or sooner if there is meaningful weakness — surgery is reasonable, because this kind of nerve pain can be genuinely debilitating. For a herniated disc, the usual operation is a small procedure to remove the fragment (a microdiscectomy) that relieves the nerve without fusing the level, which is exactly the kind of focused, non-destabilizing surgery I prefer. We time it together around how much it is limiting you.

The science — for the curious

Because the natural history is so favorable for disc-related cases, the main question is usually not whether you will improve, but how long you are willing to wait for relief — surgery mostly speeds up relief of leg pain rather than changing the eventual outcome. That is also why I favor the least invasive operation that solves the problem: a level that is fused stops moving, which shifts extra load onto its neighbors and can speed their wear, so whenever I responsibly can, I relieve the nerve without fusing. Progressive weakness or any red-flag symptoms below are what push toward earlier surgery.

Learn more

OrthoInfo — Sciatica: orthoinfo.aaos.org

OrthoInfo — Herniated Disk in the Lower Back: orthoinfo.aaos.org

This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.