Can multilevel lumbar spondylosis cause radicular symptoms?

Can Multilevel Lumbar Spondylosis Cause Radicular Symptoms?

Yes, multilevel lumbar spondylosis absolutely causes radicular symptoms through multiple mechanisms including foraminal stenosis from facet and uncovertebral joint hypertrophy, disc bulging or herniation, and lateral recess narrowing. 1

Mechanisms of Radicular Symptoms in Lumbar Spondylosis

Radicular symptoms in multilevel lumbar spondylosis arise from compressive pathology affecting nerve roots at multiple levels. The key pathophysiologic mechanisms include:

• Foraminal stenosis from degenerative facet joint hypertrophy and osteophyte formation, which narrows the exit foramen where nerve roots exit the spinal canal 1
• Disc displacement patterns that are characteristically cephalad and lateral in spondylolisthesis, increasing susceptibility to radicular symptoms by affecting the exiting nerve root more commonly than the traversing root 2
• Lateral recess stenosis from combined disc bulging and bony hypertrophy, though foraminal involvement is more common in spondylotic disease 3

Clinical Presentation

Patients with multilevel lumbar spondylosis and radiculopathy typically present with:

• Low back pain with radiating leg pain in one or both lower extremities, following dermatomal distributions 1
• Neurogenic claudication with weakness, sensory changes, or numbness in the lower limbs that worsens with walking and improves with rest 1, 4
• Multilevel radiculopathy affecting multiple nerve roots simultaneously, which is not uncommon in degenerative disease 1
• Symptoms predominantly from the lumbosacral region, with L4 and L5 nerve roots most frequently affected 3

Diagnostic Considerations

The relationship between imaging findings and symptoms requires careful interpretation:

• MRI demonstrates nerve root compression in 57-65% of symptomatic patients with radiculopathy, compared to 20-28% in asymptomatic individuals, though imaging abnormalities are common in pain-free patients 1
• Spondylotic changes correlate poorly with symptoms in patients over 30 years of age, as degenerative findings are ubiquitous in this population 1
• Clinical examination combined with imaging is essential, as physical examination findings show limited correlation with MRI evidence of nerve root compression 1

Management Implications

The presence of radicular symptoms from multilevel spondylosis influences treatment decisions:

• Conservative management for 6 weeks is appropriate for most patients without red flags, as most cases resolve spontaneously or with medical management and physical therapy 1
• Imaging is indicated only after failed conservative therapy in surgical or interventional candidates, or when red flags are present (trauma, malignancy, infection, cauda equina syndrome, progressive neurological deficits) 1
• Surgical decompression is effective for symptomatic multilevel stenosis, with approximately 97% of patients experiencing symptom recovery after surgery 1
• Decompression with fusion provides better long-term outcomes than decompression alone in multilevel disease, with lower reoperation rates due to restenosis or instability 1, 5

Common Pitfalls

• Avoid imaging patients with acute radiculopathy (<6 weeks) without red flags, as this leads to increased healthcare utilization without improving outcomes and may identify incidental findings that do not correlate with symptoms 1
• Do not assume all imaging abnormalities are symptomatic, since disc abnormalities, foraminal stenosis, and spondylotic changes are frequently present in asymptomatic individuals, particularly those over 30 years 1
• Recognize that multilevel involvement is common in degenerative spondylosis and requires thorough evaluation of all segments, as symptomatic stenosis or foraminal encroachment may occur at multiple levels 6