Generality
Lumbocruralgia is the medical condition resulting from the combination of back pain and pain in the anatomical areas covered by the crural nerve (thigh, leg and foot).
Damage, compression and irritation of the crural nerve or its spinal roots are almost always the result of traumas, lumbar disc hernias, lumbar vertebral tumors or large hematomas located near the spine, at the lumbar level.
In addition to the aforementioned pains, lumbocruralgia also causes numbness, tingling and weakness in the affected lower limb.
Lumbocruralgia therapy involves causal treatment and symptomatic treatment; the first aims at treating the triggering cause, while the second focuses on improving the symptomatic picture.
Timely treatment of lumbocruralgia is generally associated with a benign prognosis.
Brief anatomical revision of the crural nerve
Resulting from the lumbar plexus, the crural nerve (or femoral nerve ) is an important and voluminous peripheral nerve of the lower limbs, which - with origin at the level of the V lumbar vertebra - crosses the antero-medial part of the thigh and the medial aspect of the leg, and finally ends at the inner side of the foot.
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Containing in itself the nerve fibers of the spinal roots L2, L3 and L4, the crural nerve gives rise, along the course, to 3 groups of branches or branches, whose names are: abdominal branches (of the crural nerve), branches of the anterior division (of the crural nerve) and branches of the posterior division (of the crural nerve).
The femoral nerve covers both motor functions and sensitive functions: at the motor level, it controls the flexor muscles of the hip and the extensor muscles of the knee; on a sensitive level, however, it controls the sensitivity of the anteromedial portion of the thigh, the medial side of the leg and the medial side of the foot.
What is lumbocruralgia?
Lumbocruralgia is the medical term for a condition that causes pain in the back, associated with pain in the thigh and / or leg, exactly where the crural nerve passes along these anatomical features.
It is the combination of cruralgia and low back pain
Using strictly medical language, lombocruralgia is the combination of cruralgia and low back pain .
Also known as crural neuralgia or frontal sciatica, cruralgia is the pain radiated to the anterior and / or internal aspect of the thigh and, sometimes, also to the inner face of the leg; in other words, it is localized pain where, along the lower limb, the crural nerve flows.
Low back pain, on the other hand, is the classic back pain or back pain .
Meaning of the term lombocruralgia
The word lumbocruralgia recalls all the main characteristics of the condition to which it refers; in fact, in medicine:
- The term "loin" refers to the lumbar area of the back or spine.
- The term "crural" mainly refers to the anatomical region of the femur, hence the thigh; however it can also indicate the path of the crural nerve and, in this case, it also includes the leg and part of the foot.
- The term "algia" means "pain".
The literal meaning of lombocruralgia is "pain where the crural nerve passes and to the lumbar area of the back".
Epidemiology
According to reliable statistical studies, people over 50 would suffer the most from lumbocruralgia.
Causes
In general, lumbocruralgia is the result of damage, compression or an irritative process on the crural nerve or on the spinal roots from which the crural nerve then derives.
Main causes of lumbocruralgia
Among the main causes of damage, compression or irritation of the crural nerve or its spinal roots are:
- The traumas directed to the nerve in question or to its spinal roots. A strong trauma to the crural nerve or its roots can compromise its integrity, sometimes even in a profound way;
- A hernia of the intervertebral disc at the level of the lumbar vertebrae L2, L3 or L4. It is probably the main cause of lumbocruralgia.
Readers are reminded that the herniated intervertebral disc is a disease of the spine, characterized by the release of the so-called nucleus pulposus from one of the intervertebral discs;
- The presence, in the immediate vicinity of the spinal roots of the crural nerve (therefore at the vertebral level), of a tumor or a large hematoma . The proximity of tumors or large hematomas to nervous structures, such as the spinal roots of peripheral nerves, is very often associated with compression phenomena.
The compression of a nervous structure alters the functionality of the latter, with possible repercussions both at the motor level and at a sensitive level.
Less common causes of lumbocruralgia
More rarely, causing damage, compression or irritation of the crural nerve or one of its spinal roots are:
- Irregularity by one or more adjacent vertebrae, for example due to vertebral fractures, osteoporosis or arthrosis with formation of osteophytes ;
- The narrowing of the vertebral canal ( lumbar spinal stenosis ).
Risk factors
In light of what has been stated above regarding the causal factors, they constitute a risk factor of lumbocruralgia conditions such as:
- A herniated intervertebral disc located at the level of the vertebrae L2, L3 or L4;
- The presence of arthrosis in the spine;
- The presence of osteoporosis;
- Fractures of the L2, L3 or L4 vertebrae;
- The presence of a lumbar spinal stenosis;
- The formation of a large tumor or hematoma in the vicinity of one of the spinal roots from which the crural nerve is derived.
Symptoms and complications
The most characteristic symptoms of lumbocruralgia are pain in the anterior and / or internal portion of the thigh and back pain, usually at the level of the lumbar spine (low chest).
These two painful sensations can appear suddenly - for example after an effort - or gradually (therefore over time).
In the most severe cases of lombocruralgia, other problems can be accompanied by thigh pain and back pain, such as: pain in the medial face (internal) of the leg, numbness and tingling in the anatomical areas covered by the crural nerve, and a feeling of weakness of the affected lower limb.
Connotation of thigh and leg pain
According to the descriptions of those suffering from lumbocruralgia, the painful sensation in the thigh and leg is a burning or electric pain.
Motor consequences of a crural nerve problem
At motor level, damage, compression, or irritation of the crural nerve can cause atrophy of the quadriceps muscle and loss of extensive knee capacity and hip flexion capacity.
The precise motor-level effects of lombocruralgia depend on which portion of the crural nerve (including the roots) is subject to damage, compression or irritation.
Sensitive consequences of a crural nerve problem
At sensory level, damage, compression phenomena or irritative processes affecting the crural nerve can determine a more or less marked decrease in skin sensitivity along the anterior and / or internal thigh, on the inner face of the leg and, even in very rare circumstances, on the inside of the foot.
The precise sensory consequences of lombocruralgia are closely related to the site of the problem (it does not matter whether it is damage, compression or irritation) along the crural nerve (including the roots).
Complications
When they are particularly severe, the pains of lumbocruralgia constitute, for the patients, an obstacle to the carrying out of the simplest daily activities.
This inability to perform the most mundane everyday activities can affect the mood of those concerned and lead to the development of psychological problems, such as low mood or mild depression.
When should I go to the doctor?
Represents a valid reason, to contact the doctor of confidence and fix a check-up visit, the combination of symptoms such as back pain, thigh pain sometimes extended to the leg and foot, tingling and numbness along the lower limb and muscle weakness quadriceps.
Diagnose lumbocruralgia in a timely manner facilitates care and prevents complications.
Diagnosis
As a rule, the diagnosis of lumbocruralgia is based on:
- A thorough physical examination and a thorough medical history . They allow the doctor to know what the symptoms are, how and when the disorders have arisen, what are the characteristics of the ongoing painful sensation etc .;
- A neurological examination . Determines the health of the crural nerve and other peripheral nerves in the human body. The neurological examination is very important to understand if the symptomatology is connected to the crural nerve or to another peripheral nerve of the lower limb, whose involvement can cause symptoms similar to lumbocruralgia;
- Radiological examinations, including X-rays in the spine, nuclear magnetic resonance in the spine or CT in the spine. They serve to clarify the possible causes of lumbocruralgia. For example, the TAC or nuclear magnetic resonance allow to identify possible tumors, large hematomas or hernias of the intervertebral disc along the lumbar spine.
- Electromyography . It is an instrumental examination that allows you to study the goodness of the nervous control of a muscle or a series of muscles close together.
In a context of suspected lombocruralgia, it serves to establish once and for all if the nerve responsible for motor symptomatology is actually the crural nerve.
Why is it important to identify the causes of lumbocruralgia?
During the diagnosis of lombocruralgia, the identification of the precise trigger is important for at least two reasons:
- To be able to plan the most appropriate therapy;
- Because among the possible causative factors there are very serious conditions (such as tumors with vertebral site), which deserve timely treatment.
Therapy
The treatment of lumbocruralgia provides, first of all, a therapy aimed at treating the triggering causes ( causal therapy ) and, secondly, a therapy aimed at alleviating the symptoms ( symptomatic therapy ).
Causal therapy
Causal therapy varies depending on the cause of lumbocruralgia.
For example, the causal therapy of a lombocruralgia due to a vertebral tumor consists in the surgical removal of the tumor mass, which compresses the crural nerve; otherwise, the causal therapy of a lombocruralgia due to a herniated intervertebral disc involves all those conservative and / or surgical remedies specifically indicated to restore the normal structure of the altered intervertebral disc.
The effectiveness of causal therapy is strictly dependent on the treatability of the triggering causes; in fact, there are treatable conditions that are more successful than others.
Symptomatic therapy
The classic symptomatic therapy adopted in the case of lumbocruralgia involves:
- Rest from physical activity, but not immobility
- The use of non-steroidal analgesics and anti-inflammatory drugs ( NSAIDs ). Both analgesics and non-steroidal anti-inflammatory drugs are drugs capable of alleviating pain, thus providing relief to the patient.
At a possible ineffectiveness of analgesics and NSAIDs combined with severe pain, treating physicians respond with intravenous corticosteroid administration; corticosteroids are very powerful anti-inflammatory drugs, whose prolonged use can however have unpleasant side effects (eg: osteoporosis, diabetes, cataracts or obesity).
Prevention
There is the possibility of preventing only certain forms of lumbocruralgia; this is due to the fact that, among the possible causes of this painful condition, there are avoidable and unavoidable ones.
How to prevent lombocruralgia from herniated intervertebral disc
One of the preventable forms of lumbocruralgia is lombocruralgia due to the herniated intervertebral disc with lumbar site. For this condition (which is the most common form of lombocruralgia in the general population), prevention is based on at least 4 fundamental points, which are:
- Maintaining a good muscle tone, especially those muscles that doctors recognize as " core ". The " core " is the functional part of the human body given by the set of abdominal, oblique, lumbar and paravertebral muscles;
- Stretching to improve the flexibility of the muscles of the lumbosacral tract of the back and of the ischio-crural muscles;
- Acquisition of the correct technique of lifting a weight (erect torso, flexed knees etc.);
- Proper eating habits, weight control, regular physical activity and well-being-oriented lifestyle.
Prognosis
The prognosis in case of lombocruralgia depends on some factors, including:
- The triggering causes. As stated, there are causes of lumbocruralgia curable with more success than others. Clearly, lombocruralgia due to treatable causes will tend to have a better prognosis than lumbocruralgia due to less treatable causes;
- Early diagnosis and treatment. The treatment of a lumbocruralgia identified at onset provides definitely better results than the treatment of a lombocruralgia diagnosed at an advanced stage, perhaps characterized by complications;
- The way in which the patient adheres to the planned therapeutic plan. To get the most out of treatments for lumbocruralgia, the patient should carefully follow the medical instructions.
