Which spinal disorders cause both axial pain (back or neck) and disturbances in neurologic function of the limb (leg or arm)?
Three syndromes are recognized in which spinal disorders cause both back or neck pain and neurologic dysfunction. The following examples are from the lumbar spine:
- Herniated disc causing a single nerve root compression (leg pain > back pain). Clinical features include positive straight leg-raising test and radicular pain in the limb disproportionate to pain in the spine. Loss of strength, reflex, and sensation occurs in the territory of the compressed root.
- Lateral recess syndrome (leg pain ≥ back pain). Single or multiple nerve roots on one or both sides become compressed. Pain in the limb is usually equal to or greater than that in the spine. Symptoms are brought on by either walking or standing and are relieved with sitting. Testing by straight leg raise may be negative.
- Spinal stenosis (leg pain < back pain). Multiple nerve roots are involved, and the pain in the spine is significantly greater than that in the limb. Symptoms develop with standing or walking. Impairment in bowel and bladder dysfunction as well as sexual dysfunction may occur.