The L5 root arises at vertebral level L1/2 and transverses the interspace of L1/2, L2/3 L3/4 and L4/5. Damage to this root can theoretically occur at several levels: A central disc at L2/3 or L3/4, or a posterolateral disc at L4/5, or a lateral disc stenosis at L5/S1.
The disc protrusions are not uniform. The most common protrusion is in the posterolateral direction. Central or posterior disc protrusions are less common. Also sequestrated tissue from a disc protrusion may protrude and float between segments (see Fig. 6).
In addition to disc protrusions, degenerative spine changes, osteophytic bars and spurs, chronic bulging discs, arthrithic and thickened laminae and pedicles, and hypertrophied facets may either compress roots or exert chronic compression in intervertebral foramina.
Virtually all patients suffer from "sciatica": radiating leg pain that increases with Symptoms sitting, and can be exacerbated with coughing or sneezing. Usually amelioration occurs in the supine position.
Spinal stenosis and neurogenic claudication: pain, weakness, numbness, and dysesthesias occur when walking or standing. In these patients symptoms decrease by bending forward or sitting.
Differental diagnosis: In vascular claudication, it is necessary to sit down for relief. Vascular claudication is characterized by intensely crampy calves when the patient stoops or stands.
Walking uphill increases symptoms of vascular claudication, but relieves neurogenic conditions. Bicycling increases vascular symptoms but improves neurogenic symptoms.
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