L4 L5 Spine Diseases
The L4-L5 spinal level is susceptible to significant strain and impact. As the lowest segment in the lumbar spine, the L4 and L5 vertebrae must support the rest of the spine with daily motions. Additionally, as the lumbar spine is more flexible than the rest of the spine, it has a higher risk of injury.
In this article, we’ll explore L4-L5 spine diseases, their symptoms, and available treatment options.
Table of Contents
Typical Symptoms Arising From the L4-L5
Typical symptoms arising from the L4-L5 include lower back pain, stiffness, and tingling, numbness, and weakness radiating to the lower extremities.
Pain from L4-L5
The most common symptom of an L4-L5 spine disease is lower back pain. Referred pain from L4-L5 typically manifests as dull, achy pain in the lower back. However, pain from an impinged nerve in the L4-L5 segment may feel sharp, burning, or “electric”.
Lower back pain can be caused by numerous conditions – not just spinal diseases. However, if your pain doesn’t resolve after a few weeks of at-home care, visit a physician for an evaluation. Spinal diseases often need professional care to heal completely.
Back Stiffness from L4-L5
Back stiffness is a prevalent symptom of many L4-L5 diseases. Stiffness often accompanies spinal conditions as a result of increased inflammation in the spine. Inflammation is part of your immune system’s attempt to repair cell damage, but can lead to a tight, tense back.
A sedentary lifestyle can worsen back stiffness by compromising blood flow throughout the body. If your job involves hours of sitting at a desk, try to stand and walk around once every hour, or consider a standing desk.
Radiating Tingling and Numbness from L4-L5
Tingling and numbness that radiate down the legs can point to a neurological condition at the L4-L5 segment. The nerves at this spinal level supply the lower extremities and, if they become compressed, may send abnormal signals to the legs and feet.
Sciatica is a common condition that can cause tingling and numbness at the L4-L5 segment. Sciatica impacts up to 40% of people at some point in life, and it’s characterized by compression of the sciatic nerve. The sciatic nerve originates at the L4 and L5 segments.
Weakness from L4-L5
L4-L5 nerve damage can cause muscle weakness that travels to the legs and feet. This occurs because nerve damage can compromise the ability of the brain and muscles to communicate. Without proper nerve signaling, the muscles can’t function normally, and you may experience an inability to voluntarily contract certain muscles.
“Foot drop” is a common symptom relating to muscle weakness from L4-L5. With this symptom, you may be unable to lift the front portion of the foot due to nerve compression at L4-L5. As a result, the foot drops or slaps on the ground when you walk.
Over time, muscle weakness from L4-L5 can lead to muscle atrophy. As the muscles stop contracting normally, they’ll gradually lose strength and mass.
L4 L5 Spine Segment Common Treatments
L4 L5 spine segment common treatments include physical therapy, lifestyle adjustments, chiropractic care, medications, spinal steroid injections, radiofrequency ablation, and surgery.
Nonsurgical Treatments for L4-L5
Non-surgical treatments for L4-L5 include physical therapy, lifestyle adjustments, chiropractic care, medications, spinal steroid injections, and radiofrequency ablation.
L4-L5 Physical Therapy
Physical therapy is a natural treatment for L4-L5 conditions. Your physical therapist will work with you to reduce stress on the L4-L5 segment by improving spinal alignment, strengthening the core and back muscles, and correcting inefficient movement patterns. Many PTs also offer complementary therapies, like acupuncture, massage, and electromagnetic stimulation, to further reduce inflammation.
L4-L5 Lifestyle Adjustments
Your physician will likely recommend a combination of lifestyle adjustments to support the spine’s healing process. Common recommendations include:
- Sticking to a low-impact exercise regimen with activities like:
- Walking
- Swimming
- Water aerobics
- Stationary cycling
- Avoiding a sedentary lifestyle; individuals with desk jobs may consider:
- Purchasing a desk chair with lumbar spine support
- Standing up at least once per hour during the workday
- Switching to a standing/convertible desk
- Eating a nutrient-rich, anti-inflammatory diet and avoiding:
- Processed foods
- Added sugar
- Alcohol
- Red meat
- Quitting smoking, as nicotine reduces blood flow to the spine and compromises the body’s healing process
- Improving your posture to reduce excessive impact on the L4 and L5 vertebrae
L4-L5 Chiropractic Care
Chiropractic care is a drug-free treatment method for conditions impacting the neuromusculoskeletal system. It involves spinal manipulation, targeted massage, non-surgical spinal decompression, and lifestyle recommendations. Benefits of chiropractic care for L4-L5 conditions include:
- Improved spinal alignment
- Reduced inflammation
- Improved circulation to the spine
- Improved range of motion in the spine
- Reduced back pain
- Less reliance on pain medications
L4-L5 Medications
Medications can provide symptom relief and anti-inflammatory benefits for L4-L5 conditions. While it’s important to consider potential side effects and complications, medications can help manage your symptoms alongside physical therapy and lifestyle modifications.
The most widely recommended medications for L4-L5 pain are NSAIDs (non-steroidal anti-inflammatory drugs). These medications lessen pain and inflammation, making them effective for many lumbar spine conditions. Various NSAIDs are available over the counter, but your physician may recommend prescription-strength formulations if appropriate.
Muscle relaxants can help with muscle spasms from L4-L5 conditions. Muscle relaxants are only available with a prescription in the United States.
L4-L5 Steroid Injections
Epidural steroid injections are injections of steroid medication in the spine’s epidural space to temporarily alleviate pain and inflammation. Though effective for L4-L5 conditions, steroid injections should be used sparingly, as excessive use can lead to tissue degeneration.
L4-L5 Radiofrequency Ablation
Radiofrequency ablation, or RFA, is a minimally invasive, non-surgical treatment for many conditions, including chronic lower back pain. It uses currents of radiofrequency energy to safely heat and destroy targeted areas of nerve tissue. This blocks pain impulses sent from the nerve to the brain, providing lasting pain relief.
Patients can return to their normal activities quickly after RFA, and complications are rare. However, the nerve tissue can eventually regenerate, so it’s not a permanent solution for L4-L5 pain.
Surgical Treatments for L4-L5
Surgical treatments for L4-L5 include laminectomy, discectomy, foraminotomy, L4-L5 fusion, and fusion alternatives, like the TOPS System.
Your physician will only consider L4-L5 surgery after non-surgical treatments have failed to improve your symptoms over several months or years. Surgery may also be recommended if you’re experiencing severe neurological symptoms or disability.
All forms of surgery, including surgical treatments for L4-L5, present certain risks, including:
- Infection
- Blood clots
- Recurrent symptoms
- Bleeding
- Tissue damage
- Cerebrospinal fluid leakage
Your physician will go over these risks with you and ensure you’re a good candidate for the suggested procedure.
L4-L5 Laminectomy
Laminectomy is a surgical procedure that removes part or all of the lamina. The lamina is a small section of bone that acts like a roof for the back of the spinal cord, protecting it against damage. In removing the lamina, your surgeon can create more space in the spinal canal, resolving symptoms of L4-L5 nerve impingement and spinal stenosis.
L4-L5 Discectomy
L4-L5 discectomy involves surgically removing some or all of a damaged disc in the lumbar spine. It’s commonly done for individuals with a bulging or herniated disc causing spinal nerve impingement.
Many surgeons today prefer microdiscectomy, a minimally invasive form of the traditional discectomy procedure. It uses visual enhancement (i.e. a microscope or loupes) to magnify the surgical site, facilitating a smaller incision and less tissue disturbance.
L4-L5 Foraminotomy
In foraminotomy, your surgeon will enlarge the foramen – the openings through which spinal nerves travel. This creates more space around the spinal nerves to relieve compression and facilitate healing. L4-L5 foraminotomy is commonly performed for lumbar spinal stenosis and nerve impingement.
Lumbar Fusion
Laminectomy, discectomy, and foraminotomy are all classified as spinal decompression procedures. While these procedures are often effective at alleviating nerve compression, they can compromise the spine’s stability. To combat this, spinal surgeons have conventionally performed spinal fusion.
During L4-L5 fusion (which is typically done immediately after the spinal decompression procedure), the surgeon positions bone graft material in between the L4 and L5 vertebrae. They may also use hardware, like rods, screws, and plates, to keep the bones in place as the graft heals. Over several months, the graft will permanently fuse the L4-L5 segment to stabilize the spine.
While fusion can restabilize the spine after decompression, it involves various risks, including:
- Failed fusion, recurring pain, and need for reoperation
- Adjacent segment disease, or ASD, a condition in which the adjacent vertebrae degenerate more rapidly as they compensate for the fused segment
- Reduced spinal mobility
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The TOPS System
The TOPS System is a mechanical implant device the FDA has deemed superior to spinal fusion for lumbar spinal stenosis and spondylolisthesis. It replaces the tissues removed during spinal decompression surgery to restore stability without compromising your mobility. TOPS allows the spine to move in all directions (flexion, extension, axial rotation, and lateral bending) and blocks sheer forces on the lumbar spine. Indicated for use at a single level between L2 and L5, the TOPS System is an ideal, FDA-approved replacement for L4-L5 spinal fusion. Find a TOPS surgeon in your area today!
