What part of the spine causes foot numbness?

Thoracic Radiculopathy

Definition/Description [ edit | edit source ]

Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine. This is the least common location for radiculopathy. The symptoms often follow a dermatomal distribution, and can cause pain and numbness that wraps around to the front of your body..

• The pinched nerve can occur at different areas along the thoracic spine
• Symptoms of radiculopathy vary by location but frequently include pain, weakness, numbness and tingling.
• A common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation or other conditions.
• Radiculopathy symptoms can often be managed with nonsurgical treatments, but minimally invasive surgery can also help some patients.

The most important structures which are involved with a thoracic radiculopathy are the:

• Thoracic vertebrae (T1-T12)
• Intervertebral disc of the thoracic vertebrae,
• 12 pairs of spinal nerve roots,
• 12 rami — posterior rami innervate the regional muscles of the back, ventral rami innervate the skin and muscles of the chest and abdominal area. [1]

Epidemiology /Etiology [ edit | edit source ]

Unknown, the diagnosis of thoracic radiculopathy is overlooked.

Thoracic radiculopathy has been infrequently reported and described as uncommon.

Radiculopathy typically is a mechanical root compression , most commonly caused by:

• Diabetes mellitus — 15% insulin-dependent and 13% non-insulin-dependent have diabetic thoracic polyradiculopathy. [2]
• Degenerative spine changes such as disc herniation and spondylosis.

Other possible causes of mechanical root compression are a metastatic tumor, trauma, scoliosis, viral infection/inflammation, connective tissue disease and tuberculosis.

Characteristics/Clinical Presentation [ edit | edit source ]

• A person may experience pain in the chest and torso when the nerve compression or irritation occurs in the mid back region.
• Thoracic radiculopathy is an uncommon condition that may be misdiagnosed as shingles, heart, abdominal, or gallbladder complications.

Symptoms associated with thoracic radiculopathy include:

• Burning or shooting pain in the rib, side, or abdomennumbness and tingling

The symptoms of thoracic radiculopathy, regardless of the cause, are often not recognized, as there is typically no associated motor deficit.

• When the etiology is disc herniation or trauma, motor deficit or myelopathy may be observed in the advanced stages.
• The typical presentation of band-like thoracic or abdominal pain can mimic a myriad of conditions .
• With many differential diagnoses to consider, it is not surprising that thoracic radiculopathy is often not discovered for months, or years, after symptoms arise [3]

Diagnosis [ edit | edit source ]

In addition to a physical exam and symptom review, doctors may diagnose radiculopathy using:

• radiologic imaging with X-ray, MRI, and CT scans
• electrical impulse testing called electromyography or EMG, to test nerve function
• The exclusion of other causes of pain is the most important step in the diagnostic procedure as there are a lot of generators of thoracic pain and differentiating these differential diagnoses will be difficult [1]

• Postherpetic neuralgia
• Chronic abdominal wall pain
• Malignancy
• Other spinal disorders (e.g. spinal cord tumors, compression by intervertebral discs) [4]
• Spinal: Infectious, neoplastic (primary, metastatic), degenerative (spondylosis, spinal stenosis, facet syndrome, disc disease/HNP), metabolic (osteoporosis, osteomalacia), deformity (kyphosis, scoliosis, compression fracture, somatic dysfunction), neurogenic (radiculopathy, Herpes Zoster, anteriovenous malformation)
• Extraspinal: Intrathoracic (cardiovascular, pulmonary, mediastinal), Intra abdominal (Hepatobiliary, gastrointestinal, retroperitoneal), Musculoskeletal (Post-thoracotomy syndrome, polymyalgia rheumatica, myofascial pain syndrome, somatic dysfunction, rib fractures, costochondritis), Neurogenic (Intercostal neuralgia, peripheral polyneuropathy, RSD/CRPS)

Outcome Measures [ edit | edit source ]

Examination [ edit | edit source ]

• Symptoms (already discussed earlier). [5]
• Due to non-universal tenderness and the sensory changes, it is not reliable to do a sensory examination.
• Physical examination is not the best way to evaluate thoracic radiculopathy, unlike the lumbosacral and cervical radiculopathies the affected muscles cannot be tested isolated.
• The examination will rather be used to exclude other diagnoses then to determine a thoracic radiculopathy. [1]

Thus the examination will be done with more medical strategies and therefore we can use: EMG, MRI, CT, radiographs

Medical Management [ edit | edit source ]

• non-steroidal drugs, such as ibuprofen, aspirin or naproxen
• oral corticosteroids or injectable steroids
• narcotic pain medications
• physical therapy
• ice and heat application

Physical Therapy Management [ edit | edit source ]

Physical modalities of the therapy include:

• heat,
• ultrasound
• TENS.
• Spinal extension exercises.. [1]
• Rest Education: avoid the activities that produce the pain (bending, lifting, twisting, turning, bending backwards, etc).
• Apply ice in acute cases to the thoracic spine to help reduce pain and associated muscle spasm.
• An exercise regiment designed specifically to address the cause of the symptoms associated with pinched nerve and improve joint mobility, spinal alignment, posture, and range of motion.
• Restore joint function ( eg Spinal manipulations or mobilisations[6] )
• Improve motion
• Help the return of full function.

Clinical Bottom Line [ edit | edit source ]

• In mild cases many patients found that rest, ice and medication were enough to reduce the pain. Physical therapy is recommended to develop a series of postural, stretching and strengthening exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a return of symptoms.

Moderate to Severe Cases

• If the problem consultation with your health care provider. Your physician should perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment. [7]

References [ edit | edit source ]

1. ↑ 1.01.11.21.3 Thoracic radiculopathy, Ryan C. O’Connor et al., Physical & Medical Rehabilitation Clinics of North America, 2002 (evidence level 3B)
2. ↑ 2.02.1 Non-Surgical Interventional Treatment of Cervical and Thoracic Radiculopathies, Pain Physician, Richard Derby, Yung Chen, Sang-Heon Lee, Kwan Sik Seo, and Byung-Jo Kim, Pain Physician, 2004 (evidence level 1A)
3. ↑ Choi HE, Shin MH, Jo GY, Kim JY. Thoracic radiculopathy due to rare causes. Annals of rehabilitation medicine. 2016 Jun;40(3):534. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951374/ (last accessed 25.4.2020)
4. ↑ The Clinical Anatomy and Management of Thoracic Spine Pain, L.G.F. Giles, 2000 (table 18.1 elements of the physical examination p 288) (evidence level 5)
5. ↑ Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review of the Literature, T1-2 Disc Herniation / 199, Eun-Seok Son et al., Asian Spine Journal, 2012 (evidence level 3A)
6. ↑ T2 radiculopathy: A differential screen for upper extremity radicular pain. Sebastian D., Physiotherapy Theory and Practice, 2013 (evidence level 3B)
7. ↑ Redefine HC Thoracic radiculopathy Available from:https://redefinehealthcare.com/thoracic-radiculopathy/ (last accessed 25.4.2020)

Lumbar Radiculopathy: Treating Pain and Numbness in Your Legs

Most people will experience back pain at least once in their life. The back pain may be due to sore muscles from daily activities like exercising, or it may be pain in the spine from serious conditions. Spinal pain often leads to pain in the neck or legs. In severe cases, it can lead to emergency department visits.

The spinal cord is protected by the bones of the spine itself. The spinal cord runs from the brain down the spine, with branches of nerves into your limbs and organs. Each nerve is associated with specific parts of the body so understanding where the pain is coming from can be helpful in diagnosing the injury.

The lumbar spine, or lower part of the spine, is responsible for all sensation and motor in the legs. At the very bottom of the lumbar is the sacrum or tailbone. If you have persistent back and leg pain, or numbness, lasting 12 weeks (about 3 months), or if you have worsening pain, numbness, or weakness in your leg at any time, see your doctor for help.

This image is diagram of the spine. The yellow part, running down the middle, is the spinal cord and is surrounded by bones to protect it. The image also shows the spinal nerve exits that allow nerves to connect to various parts of the muscles and organs to perform bodily functions.

The image with the outlines of the people outlines the different sections of the body controlled by the different nerve endings. The multi-colored body shows the different sections of nerve endings that control various functions of the body while the image on the right shows the different muscle groups that are controlled by nerve endings.

What Causes Intervertebral Disc Herniation?

Disc herniation is a condition where the middle part of a spinal disc, which is soft, pushes through a crack in the outer bone casing. The spinal cord only has so much space, so when the disc is displaced, it causes compression of the surrounding nerves. Herniated discs can occur in any part of the spine, but it is most common in the lower back or lumbar spine.

There can be multiple factors causing a disc herniation. The most obvious one is some sort of trauma to the spine. If you fall or have something fall on you, you can injure the spine which could lead to disc herniation. Another cause could be lumbar disc degeneration which is the natural part of aging. Over 80% of the population will experience some form of degeneration by the age of 65. Degeneration happens when the disc naturally wears out, which means disc herniation can be caused by much less trauma or simple overuse of a worn-out disc. Repetitive movements can also cause disc degeneration, especially up-down movements that stretch and compress the spine repeatedly. Lastly, genetics plays a significant role in disc herniation. Disc herniation is the number one cause of pinched nerves.

This image compares the normal anatomy of a spine to one that has a herniated disc. In the image showing a herniated disc, you can see where the nerve is being compressed and causing pain.

What Causes Leg Pain or Numbness?

A pinched nerve in your lower back, also known as stenosis, is the top cause of leg pain or leg numbness. The location of this pinched nerve will directly affect where you are feeling the pain or numbness in your leg. The most common structure that causes compression of the nerve is the intravertebral disc being out of position, but another cause could be osteophytes, or new bone growth, in the wrong place which can lead to pinched nerves. Unstable vertebrae caused by a deformity at birth or spinal trauma can lead to shifts in the discs which in turn can pinch the nerve.

Is it Hip or Back Pain?

True hip pain will usually present itself in the groin on the affected side. Most of the time, if it is a pain from the back, it will either be going down the leg towards the foot, usually past the knee, or it will be isolated within the back itself. If the pain is coming from both, it usually presents itself in a band-like pattern across the back and into the outside of both hips and usually is a result of arthritis in the joints.

How to Prevent Pain and Numbness in the Legs

Daily stretching and strengthening exercises are the number one way to prevent these injuries. Take 10 minutes every day to practice core strengthening movements along with some light stretching. Maintaining a flexible and strong core in some ways can decompress the nerves and allow them to move easier with less pressure or less pain. Avoid heavy lifting, twisting, or deep bending motions. Instead of twisting at your waist to move, turn your entire body. Make sure to bend at your knees instead of your waist and keep heavy objects close to your body to lessen the chance of injury to your discs or spine.

The first treatment options, especially when the pain is not too severe, are physical therapy or injections. Both non-invasive options can help relieve the pain or numbness you may feel. If the symptoms persist for an extended period or the pain is overbearing, it may be time to discuss surgery options with your doctor.

Spinal stenosis

Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.

The main nerve traveling down the leg is the sciatic nerve. Pain associated with the sciatic nerve usually originates higher along the spinal cord when nerve roots become compressed or damaged from narrowing of the vertebral column or from a slipped disk. Symptoms can include tingling, numbness, or pain, which radiates to the buttocks legs and feet.

Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.

Spinal stenosis is a narrowing of the lumbar or cervical spinal canal. The narrowing can cause compression on nerve roots resulting in pain or weakness of the legs. Medications or steroid injections are often administered to reduce inflammation. If the pain is persistent and does not respond to these conservative measures, surgery is considered to relieve the pressure on the nerves.

When you get up from a chair or take a walk, do you feel pain in your back, legs, shoulders, or arms? Do your arms or legs feel weaker than usual? If so, believe it or not, the problem could be in your spine, and the cause, a condition known as condition called spinal stenosis. Your spine is the column of bones that runs up the center of your back. It not only helps you stay upright but also flexes to allow you to bend and twist. These bones are called vertebrae, which are separated by spongy disks that cushion the bones so they don’t rub against each other. As you get older, these spongy disks start to shrink, while the ligaments of your spine may swell up, due to arthritis. Together, these two actions narrow and put pressure on your spinal cord, or its exiting nerves, which is called spinal stenosis. You can also get spinal stenosis if you’ve had an injury like a slipped disk. So, how is spinal stenosis diagnosed? During an exam, your doctor will try to find the source of your pain or weakness by having you go through different motions. You’ll sit, stand, walk, bend forward and backward, and lift your legs. The doctor will probably also test your reflexes with a rubber hammer, and use a feather or pin to see whether you’ve lost any feeling in feet and legs. Although there are surgical procedures to relieve the pressure on your spinal cord, trying a few measures at home first can help you avoid surgery. Physical therapy will teach you exercises and stretches to strengthen your muscles and improve your range of motion. Massage and acupuncture can be helpful for relieving back and neck pain. Putting heat or ice on a painful area can also help. Or, your doctor may recommend taking anti-inflammatory or pain-relieving medications. You can probably stay active with spinal stenosis, if you follow your doctor’s recommendations and don’t try to overdo it. Maybe you need to walk instead of jog, or play fewer holes on the golf course. If treatments at home don’t work, surgery can often help relieve your symptoms, although it doesn’t cure the condition and your pain may come back afterward. One of the biggest worries with spinal stenosis is numbness. If you can’t feel pain in your legs or feet, you may get injured and not even realize it. An untreated injury can lead to an infection. Make sure to call your doctor if you have any numbness, pain, or other symptoms of spinal stenosis, especially trouble balancing or difficulty urinating or having a bowel movement. Take care of your spine. It’s the only one you’ve got.

Causes

Spinal stenosis usually occurs as a person ages, however, some patients are born with less space for their spinal cord.

• The spinal disks become drier and start to bulge and can rupture.
• The bones and ligaments of the spine thicken or grow larger. This is caused by arthritis or long-term swelling.

Spinal stenosis may also be caused by:

• Arthritis of the spine, usually in middle-aged or older people
• Bone diseases, such as Paget disease
• Defect or growth in the spine that was present from birth
• Narrow spinal canal that the person was born with
• Herniated or slipped disk, which often may have happened in the past
• Injury that causes pressure on the nerve roots or the spinal cord
• Tumors in the spine
• Fracture or injury of a spinal bone

Symptoms

Symptoms often get worse slowly over time. Most often, symptoms will be on one side of the body, but may involve both legs.

• Numbness, cramping, or pain in the back, buttocks, thighs, or calves, or in the neck, shoulders, or arms
• Weakness of part of a leg or arm

Symptoms are more likely to be present or get worse when you stand or walk. They often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period without having significant pain.

More serious symptoms include:

• Difficulty or poor balance when walking
• Problems controlling urine or bowel movements

Exams and Tests

During a physical exam, your health care provider will try to find the location of the pain and learn how it affects your movement. You will be asked to:

• Sit, stand, and walk. While you walk, your provider may ask you to try walking on your toes and then your heels.
• Bend forward, backward, and sideways. Your pain may worsen with these movements.
• Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your provider will also move your legs in different positions, including bending and straightening your knees. This is to check your strength and ability to move.

To test nerve function, your provider will use a rubber hammer to check your reflexes. To test how well your nerves sense feeling, your provider will touch your legs in many places with a pin, cotton swab, or feather. To check your balance, your provider will ask you to close your eyes while keeping your feet together.

A brain and nervous system (neurologic) examination helps confirm leg weakness and loss of sensation in the legs. You may have the following tests:

• Spinal MRI or spinal CT scan
• X-ray of the spine
• Electromyography (EMG)

Treatment

Your provider and other health professionals will help you manage your pain and keep you as active as possible.

• Your provider may refer you for physical therapy. The physical therapist will teach you stretches and exercises that make your back muscles stronger.
• You may also see a chiropractor, a massage therapist, and someone who performs acupuncture. Sometimes, a few visits will help your back or neck pain.
• Cold packs and heat therapy may help your pain during flare-ups.

Treatments for back pain caused by spinal stenosis include:

• Medicines to help relieve back pain.
• A type of talk therapy called cognitive behavioral therapy to help you better understand your pain and teach you how to manage back pain.
• An epidural spinal injection (ESI), which involves injecting medicine directly into the space around your spinal nerves or spinal cord.

Spinal stenosis symptoms often become worse over time, but this may happen slowly. If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery.

• Surgery is done to relieve pressure on the nerves or spinal cord.
• You and your provider can decide when you need to have surgery for these symptoms.

During some spinal surgeries, the surgeon will remove some bone to create more room for your spinal nerves or spinal column. The surgeon will then fuse some of the spine bones to make your spine more stable. But this will make your back more stiff and cause arthritis in areas above or below your fused spine.

Outlook (Prognosis)

Many people with spinal stenosis are able to be active with the condition, although they may need to make some changes in their activities or work.

Spine surgery will often partly or fully relieve symptoms in your legs or arms. It is hard to predict if you will improve and how much relief surgery will provide.

• People who had long-term back pain before their surgery are likely to have some pain after surgery.
• If you needed more than one kind of back surgery, you may be more likely to have future problems.
• The area of the spinal column above and below a spinal fusion is more likely to be stressed and have problems and arthritis in the future. This may lead to more surgeries later.

In rare cases, injuries caused by pressure on the nerves are permanent, even if the pressure is relieved.

When to Contact a Medical Professional

Contact your provider if you have symptoms of spinal stenosis.

More serious symptoms that need prompt attention include:

• Difficulty or poor balance when walking
• Worsening numbness and weakness of your limb
• Problems controlling urine or bowel movements
• Problems urinating or having a bowel movement

References

Gardocki RJ, Park AL. Degenerative disorders of the thoracic and lumbar spine. In: Azar FM, Beaty JH, eds. Campbell’s Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 39.

Issac Z, Sarno D. Lumbar spinal stenosis. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 50.

Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J. 2013;13(7):734-743. PMID: 23830297

Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234. PMID: 26727925

Version Info

Last reviewed on: 9/20/2022

Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.