Conditions That Affect L4 and L5 Vertebrae

The L4 and L5 are the lowest vertebrae, or spinal bones, in the lumbar spine. The lumbar vertebrae are crucial for the stability of the entire spine, working together with the muscles and ligaments to support your body weight. 

Although the L4 and L5 vertebrae are larger than the vertebrae in other areas of the spine, they’re susceptible to injury. This is partially due to their weight-bearing responsibilities, along with the flexibility of the lumbar spine. 

If you’re struggling with chronic lower back pain, you may have developed a condition of the L4 and L5 vertebrae. This article will explore the conditions that can affect this region of the spine, such as nerve compression and spondylolisthesis. 

Table of Contents

What Causes L4 and L5 Disc Problems?

Poor posture, lifting heavy objects, repetitive motions, and even a traumatic injury (such as an auto accident injury) can cause L4 and L5 disc problems. 

The spinal discs are cushion-like structures located in between the vertebrae. They absorb impact and protect your vertebrae from damage. So, an injury to the L4 and L5 spinal discs can lead to back pain and nerve compression. 

One of the most common L4 and L5 disc problems is lumbar disc herniation. Disc herniation occurs when the interior of the disc, called the nucleus, pushes out through a crack in the disc exterior, or annulus.

A herniated L4 or L5 spinal disc usually develops when the disc is forced to undergo excessive pressure or strain. Additionally, the spinal discs become thinner and weaker with age, so older individuals are more likely to experience lumbar disc herniation. 

According to research published by StatPearls, the prevalence of lumbar disc herniation is 1% to 3% of patients, with the greatest prevalence among 30 to 50-year-olds. 

What Nerves Are Affected by L4 and L5?

The sciatic nerve is affected by L4 and L5. It encompasses the L4 nerve, L5 nerve, and various sacral nerves. 

As the largest nerve in the human body, the sciatic nerve extends from the lower back through the back of each leg. Conditions affecting the L4 and L5 vertebrae can irritate the sciatic nerve, leading to sciatica symptoms. The most common symptoms of sciatica include radiating lower back pain, numbness, and weakness. 

What Is the Degeneration of L4 and L5?

Degeneration of L4 and L5 is the progressive loss of the natural function and structure of the lumbar vertebrae. 

Usually, L4 and L5 degeneration results from the natural aging process. Aging causes reduced bone mass, reduced muscle mass, and thinning spinal discs, all of which can contribute to L4 and L5 degeneration. 

What is L4-L5 Spinal Stenosis?

L4-L5 spinal stenosis is a common condition that develops when the spinal canal narrows. It usually results from age-related degeneration of the lumbar spine, which can cause thickened spinal ligaments, herniated discs, and bone spurs from osteoarthritis. As the spinal canal narrows, the nerves that supply the affected area can become compressed. 

What Is L4-L5 Nerve Compression?

L4-L5 nerve compression occurs when the nerves located at the L4-L5 vertebrae are constricted. This leads to inflammation and irritation, which may have a variety of symptoms. 

The most prevalent symptoms of L4-L5 nerve compression include:

  • Sharp, burning, or radiating pain
  • Lower back stiffness
  • Numbness in the lower back and extremities
  • Tingling that radiates to the lower extremities
  • Weakness in the lower extremities
  • Loss of coordination in the lower extremities

L4 L5 Root Compression Symptoms

L4 L4 root compression symptoms may include:

  • Burning pain: Many people describe pain from L4 L5 root compression as a burning sensation that extends from the lower back through the buttocks and into the legs. This symptom is similar to sciatica, but stems from the L4 L5 nerve roots, rather than the sciatic nerve. 
  • Radiating pain: Any pain that radiates from the L4 L5 level to the lower extremities may indicate spinal nerve root compression. This pain is often described as sharp, stabbing, or shooting. 
  • Tingling: L4 L4 root compression can trigger a tingling or “pins and needles” sensation in the lower extremities. 
  • Leg weakness: Along with leg pain, L4 L5 nerve root compression may cause weakness in the legs. This can make it difficult to walk or stand, especially for long periods.
  • Foot drop: Foot drop can result from a few different conditions, including L4 L5 root compression. This symptom refers to trouble lifting the front area of the foot, causing the foot to drop or slap onto the ground with each step.
  • Leg muscle cramps or spasms: L4 L5 root compression can cause cramping or spasms in the leg muscles, especially at night. This occurs because the compressed nerve root sends abnormal signals, causing the leg muscles to contract or spasm unnecessarily.  

What Are the Symptoms of L4-L5 Nerve Damage?

The symptoms of L4-L5 nerve damage are typically chronic lower back pain, numbness, tingling, and weakness that radiate to the legs and feet. 

Spinal nerve damage can be severe. If you experience the symptoms listed above, make sure to schedule an appointment with your physician. But, keep an eye out for the following warning signs of severe lumbar nerve compression, which may require emergency care:

  • Abrupt loss of bladder or bowel control
  • Severe or worsening numbness between the legs, at the back of the legs, and in the inner thighs
  • Severe weakness and pain that extends into one or both legs and make it difficult to move

Can L4 and L5 Cause Hip Pain?

L4 and L5 damage can cause hip pain. This is due to the path of the sciatic nerve, which travels from the lower back through the hips. 

When the nerves in the L4-L5 region of the spine become compressed and irritated, the pain can travel from the back to the hips. Symptoms that radiate from the lower back to the hips are common in cases of L4-L5 disc herniation.

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Additionally, osteoarthritis and lumbar strains and sprains in the L4-L5 region can cause hip pain. Osteoarthritis is a type of arthritis caused by the gradual breakdown of cartilage in the joints. On the other hand, lumbar sprains and strains are a type of injury relating to the ligaments and muscles in the spine. 

Can L4 L5 Cause Pain in the Buttocks?

L4 L5 damage can cause pain in the buttocks. This is particularly true when L4-L5 conditions irritate the sciatic nerve. 

According to a study published in BMC Musculoskeletal Disorders, the L4-L5 spinal level is the primary level responsible for pain in the buttocks with a lumbar herniated disc.  

What Is Spondylolisthesis at L4 and L5?

Spondylolisthesis at L4 and L5 is a spinal condition that develops when a vertebra slips out of position, falling onto the vertebra below it. It results from instability, often due to age-related changes to the spinal structures. 

The L4-L5 spinal level is the second most common region of the spine to develop spondylolisthesis, topped only by the L5-S1 level. The lumbar spine is more likely to develop this condition than any other spinal region because it’s particularly flexible and undergoes more impact than the thoracic or lumbar spine. 

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Diagnosis of L4-L5 Conditions

The diagnosis of L4-L5 conditions generally involves a complete medical history, physical exam, and imaging tests to pinpoint specific issues with the spinal bones or soft tissues. 

  • Medical history: The first step of diagnosing L4-L5 spinal conditions is usually gathering a comprehensive medical and family history. This allows your physician to identify factors (like lifestyle habits, genetic predispositions, and underlying medical conditions) that may place you at risk of problems in the L4-L5 spinal segment. 
  • Physical exam: Next, your physician will perform a physical exam to evaluate your symptoms. They may ask you to perform certain movements, like lifting your leg, to check for nerve compression that can be traced to the L4-L5 level. 
  • Imaging tests: Physicians typically require imaging tests to definitively L4-L5 conditions. X-rays, CT scans, or MRIs may be used to visualize the spine and identify various issues, like bone spurs, nerve impingement, disc degeneration, spinal stenosis, and spondylolisthesis. 

Treatment Options for L4-L5 Conditions

Treatment options for L4-L5 conditions include conservative management with physical therapy, lifestyle modifications, medications, and alternative therapies, as well as surgical intervention for advanced cases. 

L4-L5 conditions, like spinal stenosis, spondylolisthesis, and herniated discs, are usually first treated with conservative methods. Lifestyle changes like reaching a healthy weight, embracing a low-impact exercise routine, quitting smoking, and improving your posture can prime the spine for healing. Physical therapy helps reduce impact on the spine and supports the body’s healing process with targeted exercises and stretches. Medications can temporarily alleviate discomfort, as can alternative therapies like acupuncture and massage. 

When conservative management fails to meaningfully improve back pain, neurological symptoms, and overall function, your physician may suggest surgery as the next treatment option. Spinal decompression is often done for L4-L5 conditions to remove the tissues pressing on spinal nerves. Thankfully, minimally invasive spine surgery is now widely performed to reduce the risks and downtime associated with conventional back surgery. 

The TOPS System is a dynamic spinal implant that replaces the tissues removed during spinal decompression surgery to restore stability and preserve motion. It earned a superiority-to-fusion claim from the FDA, as it effectively stabilizes the spine without permanently fusing the affected vertebrae. This reduces the risk of complications, like adjacent segment degeneration and fusion failure, while shortening the recovery process. 

Rehabilitation and Recovery

The rehabilitation and recovery process following surgical treatment for L4-L5 spinal conditions involves rest, gentle movement, and healthy lifestyle habits. For the best possible result, keep these tips in mind:

  • Follow your doctor’s aftercare instructions to a T. These instructions are personalized to your condition and intended to keep you safe. Don’t stray from them, and make sure to ask for your doctor’s clearance before performing physical activities after the procedure. 
  • Prepare for the recovery process. From stocking your freezer with nutritious meals to placing essential items at shoulder level to keep you from reaching, prepping for recovery will facilitate the healing process. Various tasks around the house, from cooking to laundry, can be challenging as you’re recovering from surgery. Prepare accordingly and ask for your loved ones’ help. 
  • Limit bed rest. While some bedrest is unavoidable after surgery, don’t spend too long in one position. Prolonged bed rest can impart pressure on the spine and contribute to weakened muscles. Try to stand and take short walks in the early recovery stages, before you return to a low-impact exercise routine. 

If you’re struggling with any of the symptoms listed in this article, schedule an appointment with a spine specialist in your area to learn about the treatment options available to you.