From the Guidelines
Right lower lumbar pain during cervical flexion is most likely caused by referred pain from the cervical spine, specifically the C5-C6 and C6-C7 disc levels, which share a common nerve root with the lower back 1.
Key Points to Consider
- The convergence of nociceptive inputs from the cervical and lumbar spine on the dorsal horn of the spinal cord is thought to mediate this phenomenon, resulting in the perception of pain in the lower back 1.
- Mechanical pain associated with facet joints, intervertebral discs, muscles, or fascia represents the majority of nontraumatic cervical or neck pain, and may contribute to referred pain in the lower back 1.
- Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-800mg every 8 hours for 7-10 days, or muscle relaxants like cyclobenzaprine 5-10mg every 8 hours for 3-5 days, may provide relief from symptoms.
Important Considerations
- A thorough evaluation of the patient's medical history is critical to accurately guide imaging and treatment, as cervical neuropathic pain can have various etiologies, including tumor, infection, inflammation, and vascular causes 1.
- Clinical signs or symptoms suggesting meningitis, neck soft-tissue infection, or upper respiratory infection should be managed according to separate clinical guidelines 1.
From the Research
Possible Causes of Right Lower Lumbar Pain during Cervical Flexion
- Cervical radiculopathy, which describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine 2
- Degenerative disease in the cervical spine, which can cause cervical radiculopathy and subsequent pain in the lower lumbar region during cervical flexion 2, 3
- Changes in the foraminal size and nerve root motion during cervical flexion, which can exacerbate pain in patients with cervical disc herniation or cervical spondylosis 3
- Referred pain from the cervical spine, which can cause pain in the lower lumbar region during cervical flexion 4, 5
Mechanisms of Pain
- Compression or irritation of nerve roots in the cervical spine, which can cause pain in the upper extremities and potentially refer pain to the lower lumbar region 2, 3
- Changes in the foraminal size and nerve root motion during cervical flexion, which can exacerbate pain in patients with cervical disc herniation or cervical spondylosis 3
- Degenerative changes to the vertebrae, which can cause spinal stenosis and subsequent pain in the lower lumbar region during cervical flexion 5
Diagnosis and Treatment
- A thorough history and physical examination are necessary to diagnose the cause of right lower lumbar pain during cervical flexion 4, 5
- Imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT), may be necessary to confirm the diagnosis and guide management 4, 5
- Treatment options may include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and epidural steroid injections, depending on the underlying cause of the pain 2, 4, 5, 6