Cervical, Thoracic, Lumbar (frequently called Sciatica) and Sacral Radicular Pain
This is a shooting, stabbing, electrical pain or sometimes just numbness or tingling that can result in sensory changes or motor (muscle) weakness, both superficially and deep. The pain usually occurs from a source at the nerve roots after they leave the spinal cord but is perceived at a distant location.1 For example, a person could have pain, numbness and weakness in the forearm and thumb from compression of the C6 nerve root at the C5-6 level. Radicular pain can occur anywhere from the base of the skull to the toes. Frequently we see pain originating in the lower back (Lumbar) spine, L5, S1 or S2 nerve roots, that cause symptoms radiating down the back of the lower extremity into the calf or foot. Many people refer to this as “Sciatica” but today we try to avoid this term because it is misleading as the pain does not actually arise from the “Sciatic Nerve.”
Radicular pain occurs when one or more various structures compress or irritate the spinal nerves. This leads to painful inflammation of the nerves and when compression is severe, there can ischemia (loss of blood supply) resulting in severe irreversible damage to the nerves. At times there may be no actual compression of the nerves but a “chemical” irritation may occur from inflammatory substances present.
- Disc bulges, degeneration, herniation, protrusions and extrusions: Radiologists use a lot of different terms to describe what the see on an MRI when intervertebral discs extend in the central spinal or foraminal canal potentially compromising the spinal nerves.
- Disc Osteophyte Complexes and Osteophytes: Degenerative edges of the vertebrae, bone spurs or arthritis, merge with bulging discs contributing to spinal narrowing or nerve compression.
- Spinal Canal Stenosis: This is a narrowing of the spinal canal where either the spinal cord or spinal nerves run. It causes compression and injury of the nerves.
- Foraminal Stenosis or Narrowing
- Ligamentum Flavum Hypertrophy: This is a tough ligament at the rear of the spinal canal that connects the vertebrae. When the intervertebral discs bulge out their height is reduced, reducing the distance between the vertebrae, causing this ligament to buckle inward, further narrowing the spinal canal
- Epidural Lipomatosis: Surrounding the spinal cord is the epidural space. Normally there are some fat cells in this region but in certain people this can be significantly increased compressing the spinal cord and nerves. It is a tough challenge to treat but we frequently see improvement with weight loss.
- Annular Disc Tear and Annular Fissures: The outer portion of the intervertebral disc has a tough rubbery texture. If a severe injury causes a rupture, inflammatory substances (cytokines) may leak out from the center (nucleus pulposus) causing irritation of the nerve roots. The tear or fissure may also be the cause of Discogenic Back Pain.
1 Classification of Chronic Pain, Second Edition (Revised), 2012, International Association for the Study of Pain.