L5 syndrome is caused by irritation or compression of the L5 nerve root due to various causes. The result is pain, sensory disturbances or paresis. Rapid diagnosis followed by conservative or surgical treatment is essential to avoid worsening of the symptoms or consequential damage.
What is L5 Syndrome?
The diagnosis of the L5 syndrome is initially carried out by means of an anamnestic interview and a neurological examination. See AbbreviationFinder for abbreviations related to L5 Syndrome.
L5 syndrome is one of the so-called root compression syndromes. It is caused by irritation or damage to the L5 nerve root, which exits the spinal canal between the last lumbar vertebra and the first sacral vertebra.
The result is pain, loss of sensitivity and, in the worst case , paresis. L5 syndrome, together with S1 syndrome, accounts for about 95 percent of all back-leg pain caused by herniated discs in the lumbar spine.
Causes
In most cases, the cause of L5 syndrome is a herniated disc. Both the bulging of the gelatinous core and its exit from the fibrous ring lead to damage or irritation of the nerve root. Benign and malignant tumors or space-occupying cysts can also put pressure on the nerve root and cause the symptoms.
Another cause can be spinal canal stenosis. This is caused, for example, by a narrowing of the joint space or by pathological changes in the vertebrae and the resulting bony prominences that protrude into the spinal canal and constrict the nerve root.
Symptoms, Ailments & Signs
Whatever the underlying cause of L5 syndrome, the symptoms always present in the same way. Pain occurs in the affected dermatome, i.e. the area that is supplied by a specific nerve. In the case of the L5 nerve root, this is the area on the posterior thigh, the outer knee, and the front and lateral lower leg.
The back of the foot and the big toes are also affected. If a tumor is the cause of the symptoms, the pain occurs mainly at rest. In contrast, stress pain usually occurs when the trigger is a herniated disc. An increase in pressure within the spinal canal, such as occurs when coughing or sneezing, increases the sensation of pain.
Apart from pain, there can be sensory disturbances in the dermatome. If the damage is more extensive, not only the sensory but also the motor nerve fibers can be affected. In this case, not only sensory disturbances occur, but also paralysis. The restriction in the hip joint and a drop in the foot greatly reduce the mobility of the leg and make a physiological gait more difficult.
Diagnosis & course of disease
The diagnosis of the L5 syndrome is initially carried out by means of an anamnestic interview and a neurological examination. Attention is paid to pain, sensitivity, motor deficits and weakened or absent reflexes. The symptoms are always viewed in side comparison.
X- rays or magnetic resonance imaging of the lumbar spine are used as imaging methods for precise diagnosis. Peroneal nerve paresis should be considered as a differential diagnosis. There is also a drop foot here, but there is no involvement of the buttocks or hip muscles.
If the cause of the nerve root compression is a herniated disc, an exact prognosis is difficult. Acute and pain-free phases usually alternate in younger patients, while older people are more prone to chronic pain.
With medical or therapeutic treatment, the symptoms usually improve within a few weeks, although a new incident cannot be ruled out. How quickly the recovery progresses depends heavily on the extent of the damage and the neurological deficits. In addition, the patient’s self-motivation is an important factor for the improvement of the symptoms.
Complications
L5 syndrome must always be diagnosed and treated by a doctor. It usually does not heal itself and the symptoms worsen over time. Patients primarily suffer from severe pain and swelling. The pinched nerves can also lead to paralysis and other sensory disorders, so that the patients are significantly restricted in their everyday life.
It is not uncommon for those affected to depend on the help of other people in their everyday life and can no longer do many everyday things on their own. Various emotional disorders can continue to restrict everyday life and significantly reduce the quality of life of those affected. Mobility is also restricted, so that most patients also suffer from movement disorders.
Treatment of the syndrome usually depends on the cause. In most cases, not all complaints can be completely limited. With the help of various therapies, however, the pain and swelling can be relieved. The life expectancy of those affected is usually not changed by the L5 syndrome. Furthermore, no particular complications arise during the treatment.
When should you go to the doctor?
Indefinable pain in the upper or lower leg indicates that the L5 syndrome is present. A doctor should be consulted if the pain does not subside after a few days or even worsens over time. If other symptoms or complaints become noticeable, immediate advice from a doctor is required. Those affected who experience pain when coughing or sneezing should seek medical advice. Sensory disorders or sensory disturbances are also typical signs of the rare pain syndrome and must be clarified and treated quickly.
The syndrome occurs mainly in connection with tumors or cysts. Spinal canal stenosis can also be a possible cause that needs to be clarified if signs of L5 syndrome become noticeable. People who suffer from the symptoms described as a result of an accident or an operation should consult their family doctor within the same week. In addition, a sports physician, orthopedist or internist can be consulted. If the disease is treated quickly, long-term consequences can usually be avoided.
Treatment & Therapy
Treatment depends on the cause. If a tumor has formed in the lumbar spine, an operation is definitely indicated. Bony prominences that protrude into the spinal canal can also be surgically removed. On the other hand, in the case of a herniated disc, conservative treatment methods are always used first.
Medicines relieve the pain and normalize the tone of the back muscles, which are often tense or cramped due to the pain. Transcutaneous electrical nerve stimulation (TENS) also reduces pain through controlled relaxation of the muscles. Heat applications or massages achieve the same effect in a gentle way.
However, if the herniated disc causes motor failures, immediate surgery is essential to avoid consequential damage. Here, a nerve root decompression is achieved by removing the damaged disc tissue. If necessary, a prosthesis can be used to replace the intervertebral disc.
Basically, none of the treatment measures should be continued for too long if there is no improvement. After a period of about four weeks, the pain-related, permanent relieving posture and various evasive movements cause the affected muscles to shorten and the joint capsules to shrink. This can result in chronic pain and, in extreme cases, lead to deformation or instability of the lumbar spine.
Outlook & Forecast
The prognosis is largely linked to the present cause and the stage of the disease when the diagnosis is made or when treatment begins. The sooner the L5 syndrome can be detected in a patient, the better the further developments. Depending on the cause, a treatment plan is drawn up, which can include conservative or surgical therapy.
In the case of minor complaints, the health inconveniences are alleviated by the administration of medication. In addition, training courses are carried out to optimize movement sequences and to better deal with physically demanding activities. These should bring about a long-term recovery. If the affected person sticks to the learned exercise units in everyday life, healing can be documented after a few weeks or months.
In the case of severe impairments, an operative intervention is carried out. This comes with the usual risks. As with any surgery, complications can arise. In severe cases, a prosthesis is used. If the treatment proceeds without further disturbances, further therapeutic measures are taken in the subsequent recovery process. The muscular system is stabilized and the possibilities of movement are improved. Although relief of symptoms is achieved in many patients, impairments can occur in the long term. An unfavorable prognosis is given when the pain becomes chronic or when deformation and instability cannot be corrected.
Prevention
Depending on the cause of a possible L5 syndrome, certain preventive measures can be taken. Regular and varied physical activity strengthens the trunk muscles and gives the spine the necessary stability. In addition, the intervertebral discs are nourished and kept flexible by the continuous loading and unloading.
Being overweight promotes herniated discs or degenerative processes in the spine and should be avoided if possible. An upright or dynamic posture has a positive effect on the spine, especially when working while seated.
Correct back posture is also important when lifting and carrying heavy objects in order to avoid excessive pressure on the lumbar spine. The correct execution of these movements can be learned in various courses.
Aftercare
In the L5 syndrome, the follow-up measures are very limited in most cases. Those affected should consult a doctor at an early stage and initiate treatment so that the symptoms can be alleviated at an early stage. If L5 syndrome is not treated, it can lead to serious complications that can significantly limit the life of the affected person. For this reason, a doctor should be contacted at the first sign of L5 syndrome.
Most patients are dependent on the measures of physiotherapy. It should be noted that many exercises can also be carried out at home, which speeds up the treatment. Likewise, when taking medication, it is important to ensure that the correct dosage is taken and that it is taken regularly.
If anything is unclear, always consult a doctor first. Most of those affected with L5 syndrome are dependent on the help and care of their own family, which can have a positive effect on the course of the disease. Psychological support is often necessary here so that psychological problems or depression can be prevented. As a rule, L5 syndrome does not reduce the life expectancy of the person affected.
You can do that yourself
The L5 syndrome can be counteracted with various exercises and aids. Depending on the extent of the complaints and the symptoms present, an adequate pain therapy is recommended, which can be supplemented with natural sedatives in consultation with the doctor. Changing risky lifestyle habits is one of the most important measures, as this is the only way to effectively and long-term avoid another incident.
If the causative herniated disc causes motor deficits, immediate surgery is required. Rest and bed rest are indicated after surgery. The patient should not put heavy loads on the spine for at least two to three weeks. After that, the nerve roots can be strengthened with some exercises from the field of physiotherapy.
In addition, the causes of the nervous disorder must be determined and, if possible, remedied. Sometimes the symptoms are caused by being overweight or poor posture, for example – triggers that can be treated through physical activity. Physical exercise also helps with muscle tension, but also massages and alternative measures such as acupuncture or methods from Chinese medicine. If symptoms appear again, a doctor must be consulted. With L5 syndrome there is always a risk of renewed root compression, which requires further medical treatment.