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Induced lumbosacral radicular symptom referral patterns: a descriptive study.

Michael B Furman1, Stephen C Johnson2

  • 1Department of Physical Medicine and Rehabilitation, OSS Health, 1855 Powder Mill Rd, York, PA 17402, USA.

The Spine Journal : Official Journal of the North American Spine Society
|May 26, 2018
PubMed
Summary

Lumbosacral radicular pain referral patterns often differ from standard dermatomal maps. Symptoms in the buttock, posterior thigh, or calf can originate from L3, L4, L5, or S1 nerve root irritation.

Keywords:
DermatomeEpidural injectionPainRadiculopathyReferral patternSclerotome

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Area of Science:

  • Pain Medicine
  • Neurosurgery
  • Radiology

Background:

  • Lumbosacral radicular symptoms are common in clinical practice.
  • Accurate level-specific diagnosis is critical for effective patient management.
  • Current diagnostic methods rely on correlating symptoms and imaging with dermatomal maps, which may not fully represent referred pain patterns.

Purpose of the Study:

  • To characterize the symptom referral patterns induced by lumbosacral nerve root provocation during transforaminal epidural injections.
  • To investigate if these patterns align with established dermatomal maps.

Main Methods:

  • Observational descriptive study of 71 patients with lumbosacral radicular pain undergoing transforaminal epidural injections.
  • Patients drew provoked symptom locations on pain diagrams after needle placement and injection of contrast and lidocaine.
  • Composite maps of symptom referral patterns were created for specific lumbosacral nerve root levels (L3-S1).

Main Results:

  • Of 125 injections, 87 provoked referred symptoms and were analyzed.
  • Symptom referral patterns frequently deviated from predicted dermatomal maps.
  • The most common referral pattern for L3-S1 levels involved the buttock, posterior thigh, and posterior calf.

Conclusions:

  • Provoked lumbosacral radicular symptom distribution during transforaminal epidural injections often differs from classic dermatomal maps.
  • Referred pain to the buttock, posterior thigh, or posterior calf may indicate irritation of L3, L4, L5, or S1 nerve roots.