Radiculapathy is a term describing an irritated or pinched nerve as it exits the spine. This opening is called the neural foramen. The nerve can be compressed by a bulging disc, an enlarged facet joint, or settling from degenerative disc disease. Bone spurs can also form, all of which can put pressure on the nerve. The diagram below shows a torn annulus with the contents on the nerve.
Patients will complain of back pain and spasm, as well as pain that radiates through the lower buttock down the leg into the foot. This pain is described as burning and numb. Severe cases will cause weakness in the leg or foot as well. The diagram below shows your where the pain is based on what nerve is being affected.
Radiculapathy is diagnosed by history, physical exam, and imaging. EMG and nerve conduction studies may also be performed to provide objective information of potential nerve damage. Off loading the spine with weight loss, core strengthening, and back bracing can provide relief. Minimally invasive treatments such as epidural steroid injections are very effective for mild to moderate conditions. Sometimes the compression is too severe and requires surgical correction.
Patients will ask “why not just have surgery?”. As a pain physician I see two major reasons: adjacent level disease and postoperative fibrosis of the nerve roots.
When you fuse a segment of the spine, that previously mobile segment is now rigid and results in altered normal forces above and below the fusion. Even with a perfect surgery, these forces accelerate the degenerative process across those areas leading to earlier breakdown. This is adjacent level disease. If you’re 80 years old this is not as concerning as if you’re 40 years old. The 40 year old has many years left and will likely need a revision along the way. You may need surgery, just be aware of this phenomenon.
The next is postoperative fibrosis. A perfect surgery can still result in patients laying a bed of scar at the surgical site and encasing the their nerve root in scar. This can tether the root in place, and with movement results in repetitive pulling on the nerve instead of sliding like it normally does. Again, you may need surgery, and have a perfect surgery performed, but still lay scar.
For these two reasons I believe a strong effort at conservative therapy is worth trying and remaining devoted to over the long term .