Extraforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis. Each aggravating activity or task is performed for 2.5 minutes. This study included 37 subjects aged 19 to 83 (male and female) with a mean age of 46.3 years and an average age of 14.9 years (range 23 years). National Library of Medicine Sharp pain, typically felt as a shooting and/or burning feeling that may occur in the thigh and/or inner part of the leg. Using best practices for good posture while sitting, playing sports, exercising or lifting heavy objects is also important for preventing injuries. Arthritis and the wear and tear of daily living often lead to changes in your spine that narrow the foramen. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. See Non-Surgical Treatments for Lower Back Pain, Next Page: The tumors may affect your spinal cord or the nerve roots, blood vessels, or bones of your spine. Pinched nerve - Symptoms and causes - Mayo Clinic Top Contributors - Admin, Liena Lamonte, Clay McCollum, Bo Hellinckx, Kim Jackson, Lucinda hampton, David De Meyer, Liesbeth De Feyter, Eric Robertson, Rachael Lowe, Khloud Shreif, Bram Van Laer, Lynse Brichau, Simisola Ajeyalemi, WikiSysop, Kai A. Sigel, Adam James, Rewan Elsayed Elkanafany, Mariam Hashem, Barb Clemes, Vidya Acharya and Candace Goh, Lumbosacral radiculopathy is a disorder that causes pain in the lower back and hip which radiates down the back of the thigh into the leg. Crossed Straight Leg Raise Test (Crossed Lasgue test): A test for the containment and exclusion of lumbar radiculopathy. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. A loss of bladder or bowel control, lower back pain, numbness in the saddle area, and/or weakness in both legs are signs of a rare but serious condition called cauda equina syndrome. These are some general characteristics of lumbar herniated disc pain: See Leg Pain and Numbness: What Might These Symptoms Mean? Nonpharmacologic interventions are often utilisedas well. This damage is caused by compression of the nerve roots which exit the spine, levels L1- S4. Damage from a pinched nerve may be minor or severe. (2015). Learn about neural foraminal stenosis, including how it can be treated. Phys Med Rehabil Clin N Am. 2015 Dec;9(6):958-61. doi: 10.4184/asj.2015.9.6.958. After the age of 50, radicular pain is often caused by degenerative changes in the spine (stenosis of the foramen intravertebral). Cauda equina syndrome . A nerve conduction velocity (NCV) test also called a nerve conduction study (NCS) measures how fast an electrical impulse moves through your nerve. Our website services, content, and products are for informational purposes only. [3], Diagnosed by history taking and physical examination. Selective nerve root injection was completely effective in 10 patients. It will limit your movement and let your neck muscles rest. Canadian journal of anaesthesia. This happens when you stand for a long time or when you walk. When a nerve in the spine is damaged it can cause pain, increased sensitivity, numbness and muscle weakness. Pain. Oswestry Low Back Pain Disability Questionnaire - considered as the golden standard to measure the permanent functional disability of the lower back. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar-sacral radiculopathy) and in the neck (cervical radiculopathy). Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Nerve Root Pain - Symptoms and Causes - University of Pennsylvania Ankle, knee or wrist sprains. Cooccurrence of Fragility Fracture of the Pelvis with Lumbar Degenerative Disease: A Case Report. So how long does a pinched nerve cause pain and discomfort? Physical Medicine and Rehabilitation Clinics. See additional information. Radicular pain and nerve root pain can be defined as a single symptom (pain) that can arise from one or more spinal nerve roots. Mayo Clinic Staff. Extreme lateral lumbar disc herniation in a 12-year child: case report and review of the literature. L2, L3, and L4 spinal nerves provide sensation to the front part of the thigh and inner side of the lower leg. 1 , Lumbar epidural steroid injections. Where does L2 cause pain? When you move your thighs or knees in the wrong direction, you may have a weakness. In: StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441822/ The L2, L3, and L4 spinal nerves allow you to feel sensation in your thigh and inner thigh. You can learn more about how we ensure our content is accurate and current by reading our. When subject to acute trauma, the L3-L4 motion segment may rarely undergo facet joint dislocation, fracture, and/or damage to the cauda equina. When Can You Start Riding A Bike After Arthroscopic Knee Surgery? Keep respiration normal. Pinched Nerve Diagnosis According to the American Academy of Orthopaedic Surgeons, a doctor may take an X-ray, a computed tomography (CT) scan, or a magnetic resonance imaging (MRI) scan to find the cause of the pinched nerve. The L2-l3 Disc Herniation: Causes Symptoms And Treatment Herniated discs can be found in both the lower back (lumbar spine) and the cervical spine. A herniated disc occurs when a fragment of the disc nucleus exits the annulus and travels into the spinal canal through a tear or rupture. [Updated 2019 Aug 1]. The https:// ensures that you are connecting to the Sometimes, even after your symptoms have resolved for weeks or years, they may come back. 2023 Healthline Media LLC. Moreover, the condition constitutes asignificantreason forpatient referral to either neurologists, neurosurgeons, or orthopedic spine surgeons. Nerve root pain originates from nerves that have been damaged or are compressed in the spine. Vertebrae are bones in your spine that are stacked one upon the other. Chiropractic care and decompression therapy may involve spinal manipulation to alleviate pressure from a herniated disc or bulging disc. The vertebral arch has 3 bony protrusions: a prominent spinous process in the middle and two transverse processes on either side. Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine, which is your upper back. L3-L4 Treatment. Isolated transversus abdominis and lumbar multifidus training1. Neural Foraminal Stenosis: Treatment, Symptoms, and Causes - Healthline See Ten Tips for Improving Posture and Ergonomics. Sharp, burning, or electrical pain, as well as numbness or changes in sensation, are possible symptoms. This pain has radiate to the front of the thigh in both cases. Radiculopathy can be defined as the whole complex of symptoms that can arise from nerve root pathology, including anesthesia, paresthesia, hypoesthesia, motor loss and pain. When these tissues shift or change in size, they may narrow the spaces where the nerve roots travel inside the spine or exit the spine; these openings are called foramina. Thoracic stenosis develops when the foramen in the upper portion of your back narrow. What are the symptoms of L3 nerve root compression? The L3-L4 spinal motion segment, positioned in the middle of the lumbar spine, plays an important role in supporting the weight of the torso and protecting the cauda equina (nerves that descend from the spinal cord). An abnormal reflex will develop if a herniated disc in the L3 or L4 range of discs is impinged, just below the knee, with the rubberized reflex hammer. Because the procedure is more commonly performed with a calcified disc, the risk of a safe discectomy is increased. Epub 2010 Mar 10. The symptoms may be worse when you sit, stand, or walk for long periods of time. It is not intended to provide medical advice and is not intended to provide educational resources. 7; Volume 1 Sharifi G1, Rahimzadeh A2, Fereydonyan N3, Divanbeigi A4, Kasbkar H4, Ebrahim Zadeh K1, Amiri S4, and Rezaei O1 are all Persian. Disney rash is a type of vasculitis, also called golfer's or hiker's rash because it's strongly linked to the kind of walking these activities inspire. Follow your doctors instructions regarding physical therapy and activity modifications, and your pinched nerve pain will probably be a thing of the past. Watch Now. ; Clinically oriented anatomy seventh edition; Wolters Kluwer; p 556-632; 2014, Valentyn Serdyuk; Scoliosis and spinal pain sydrome: new understanding of their origin and ways of successful treatment;Byword books; p47; 2014. In the lower extremities, a herniated disc in this region will cause nerve compression. Diagnostic value of history, physical examination and needle electromyography in diagnosing lumbosacral radiculopathy. Disc Herniation. Watch Now. While pinched nerves often heal themselves without treatment, theres no reason why you should suffer in the meantime. Diabetes. Herniated disk. [6], Lumbar radiculopathy is a disorder that commonly arises with significant socio-economical consequences. Healthline Media does not provide medical advice, diagnosis, or treatment. Lesions of the intervertebral discs and degenerative disease of the spine, most common causes of lumbosacral radiculopathy. Systemic steroids are often prescribed for acute low back pain, although there is limited evidence to support its use. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Nerve Root Impingement Symptoms, Treatment, Surgery Options Injuries can lead to stenosis and pinched nerves. Perform muscle co-contraction while walking at normal, faster and fastest speed for 5 minutes at weeks 8, 9, and 10 respectively. Perform co-contraction of the two muscles while sitting on a balance board. Clipboard, Search History, and several other advanced features are temporarily unavailable. In elderly patients who do not respond to treatment for hip and/or knee joint diseases, L3 nerve root radiculopathy should be considered as the cause of lower limb pain. Spinal Cord and Cauda Equina of the Lumbar Spine, https://www.ncbi.nlm.nih.gov/books/NBK459278/, https://www.ncbi.nlm.nih.gov/books/NBK441822/, One-Minute Stretch for SI Joint Pain Relief Video, Radiographic Tests for SI Joint Dysfunction. A radiculopathy is caused by compression, inflammation and/or injury to a spinal nerve root in the low back. In some cases, the pain may radiate down the leg or into the foot. The Maine-Seattle Back Questionnaire - A 12-item disability questionnaire for evaluating patients with lumbar sciatica or stenosis. Perform co-contraction of the two muscles while raising the buttocks off a couch from a crooked lying position until your shoulders, hips, and knees are straight. Disc Herniation. 2011 Feb. A thorough physical exam, medical evaluation, and sometimes diagnostic imaging tests are commonly needed to determine the source of pain and other symptoms. The main problem is that the nerve is pinched in the intervertebral foramen. Lumbar Herniated Disc Symptoms | Spine-health [6], Prognosis is in most cases favorable, the pain and related disabilities resolving within two weeks.[6]. Depending on the cause and severity of your foraminal stenosis and pinched nerves, several treatments are available to ease your discomfort. Before Low back pain and groin pain, as well as numbness or weakness in the upper front and/or inside thigh, are symptoms of L1. Vanti C, Turone L, Panizzolo A, Guccione AA, Bertozzi L, Pillastrini P. Kennedy DJ et al. In an acute phase, there is moderate evidence for spinal manipulation for symptomatic relief, For chronic lumbar radiculopathy, only low-level evidence was found for manipulations. Herniated disk - Symptoms and causes - Mayo Clinic You may have a herniated disk if pain: Is limited to your back, buttocks or hip. The narrowing of foramina is known as foraminal stenosis, which is very similar to spinal stenosis that affects the spinal cord. Lumbar Herniated Disc: Causes and Risk Factors. [Updated 2018 Dec 13]. Understanding the Clinical Diagnosis of a Herniated Disc, When Back Pain May Be a Medical Emergency. At this level of disc herniation, a iliopsoas muscle weakness may occur, making it difficult to walk up stairs or to the front of the thigh. Suffering from Lumbar Spinal Stenosis? Pain is experienced in the body part that the pinched nerve is involved in the function of. The most noticeable symptoms are usually described as nerve pain in the leg, with the pain being described as searing, sharp, electric, radiating, or piercing. Both over-the-counter (OTC) and prescription medications are used to treat pain stemming from L3-L4, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, tramadol, and/or corticosteroids. Treatment Options for Peripheral Artery Disease. being born with a narrow spine. or loss of reflexes. Because the nerve roots in this area of the spine primarily control sensations in your arms and hands, this is where the symptoms are most likely to occur. Unable to load your collection due to an error, Unable to load your delegates due to an error. Of note, the data supporting the use of these treatment modalities is equivocal. This is what is known as the patellar reflex. This test causes a downward and slightly lateral movement of the femoral nerve, its nerve root, and the intradural rootlet.[6]. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. The L4 and L5 nerves (along with other sacral nerves) contribute to the formation of the large sciatic nerve that runs down from the rear pelvis into the back of the leg and terminates in the foot. Learn How Bone Growth Therapy Can Help You, Get a Comprehensive Evaluation from Mayo Clinic's Spine Care Experts. 5 Ways to Increase Nitric Oxide Naturally, What You Need to Know About Leukocytoclastic Vasculitis, enlargement of ligaments around the spine, grade 1 = mild stenosis with no evidence of physical changes in the nerve root, grade 2 = moderate stenosis with no physical changes in the nerve root, grade 3 = severe foraminal stenosis showing nerve root collapse. 2013 Dec;8(6):883-93. The international consensus says that in the first 6-8 weeks, conservative treatment is indicated.[4]. What are the symptoms of L3 nerve root compression? 1999-2023 Veritas Health, LLC. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. One disadvantage of this approach is that it entails an additional expenditure of funds. An injury to the cauda equina is called cauda equina syndrome. Vertical traction for lumbar radiculopathy: a systematic review. In: Goldman-Cecil Medicine . Thoracic radiculopathy causes pain in your chest area. the annual prevalence of disc-related sciatica in the general population is estimated at 2,2%. The l2-l3 disc herniation can be treated with the surgery, the physical therapy, and the medications. government site. Two spinal nerves branch off from the right and left sides of the spinal cord or the cauda equina at each spinal segment. 2010 Mar 1;257(3):332-7. The patients' symptoms were thigh pain in 12 patients, and hip or knee pain in 5. Symptoms and Signs Stemming from L3-L4 The L3-L4 motion segment may cause muscle pain, discogenic pain, radicular (nerve root) pain, and/or radiculopathy (neurologic deficit) that typically affects the lower back and/or the legs. Disclaimer. Learn how the lumbar spinal discs function and how lower back conditions can cause back pain and/or radiating pain. Nonsurgical treatments are often tried first to treat the conditions originating from L3-L4, except for cauda equina syndrome, which must have urgent surgical consultation. The thought is that damaged nerves might interpret the temperature change as pain or tingling, which can heighten the sense of neuropathy. The spinal diseases that were associated with L3 radiculopathy were lumbar canal stenosis in 6 patients, lumbar extraforaminal stenosis and lumbar disk herniation in 5 each, and lumbar canal stenosis with degenerative scoliosis in 1. For example, weakness in the deltoid muscle while raising your arms from your sides could indicate a pinched nerve at the C4-5 level. Herniated disc with nerve root compression causes 90% of radiculopathy, underlying diseases like infections such as, Strenuous physical activity (frequent lifting), Unilateral leg pain greater than low back pain, leg pain follows a dermatomal pattern, Pain traveling below the knee to foot or toes, Numbness and paraesthesia in the same area, Straight leg raise positive, induces more pain, X-rays: to identify the presence of trauma or, EMG: useful in detecting radiculopathies but they have limited utility in the diagnosis. This may involve removing all or parts of a disc and/or vertebrae. We were able to do all of the steps without causing significant damage to the dural sac. When a nerve is compressed, the location of the symptoms will differ. Oshima Y, Watanabe N, Iizawa N, Majima T, Kawata M, Takai S. Adv Orthop. These are the most common symptoms of lumbar disk disease: Intermittent or continuous back pain. It can radiate from your back down your legs or arms, or to your chest, Many people describe back pain that feels warm, hot, or even burning. Accuracy of physical examination for chronic lumbar radiculopathy, https://www.ncbi.nlm.nih.gov/books/NBK430837/, Radiculopathy and Degenerative Spine Disease, https://www.sciencedirect.com/topics/neuroscience/lumbar-nerves, http://www.youtube.com/watch?v=JmvGHszR_X4, http://www.youtube.com/watch?v=cN0uou-nZH8. The affected nerve root for groin pain was confirmed by SNRB in half of the patients. , Numbness in the thigh and/or inner part of the leg. Learn how the lumbar spinal discs function and how lower back conditions can cause back pain and/or radiating pain. Selective nerve root injection was effective for most patients. Dislocated joints, such as a dislocated elbow or dislocated shoulder. Also important is the nature (sharp, dull, piercing, throbbing, stabbing, shooting, burning) and localisation of the pain[10]. Doctors generally dont advise wearing a back brace of any kind for pinched nerves in the low back. Iversen T, Solberg TK, Romner B, Wilsgaard T, Nygaard , Brox JI, Ingebrigtsen T. Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. But it can also be a result of a spinal injury. Cauda equina syndrome is a rare condition characterized by the spinal cord ending around the T12-L2 vertebral bodies. Spinal stenosis in the lower back can cause pain or cramping in one or both legs. Other less common causes of foraminal stenosis include: If you have pain that radiates down your arm or leg or feelings of numbness that last for several days, you should see with your doctor. This level requires extra attention and consideration when selecting the appropriate surgical technique. Youre more likely to develop foraminal stenosis and pinched nerves as you age. There was no difference among traction, laser, and ultrasound. Ten Tips for Improving Posture and Ergonomics, Lumbar Herniated Disc: What You Should Know, Lumbar Herniated Disc: Causes and Risk Factors, Non-Surgical Treatment for a Lumbar Herniated Disc. Different types of medicines can be used to ease your pain: If conservative treatments dont relieve your symptoms, you and your doctor may consider surgery. Surgery should be offered only if complaints remain present for at least 6 weeks after a conservative treatment. 2007 Dec;16 Suppl 3(Suppl 3):311-4. doi: 10.1007/s00586-007-0387-x. The test is based on stretching of the nerves in the spine. Integrated transversus abdominis and lumbar multifidus training in pain aggravating activities810. Radiculopathy can be defined as the whole complex of symptoms that can arise from nerve root pathology, including anesthesia, paresthesia, hypoesthesia, motor loss and pain. In the lower back. The bulging disk presses on the foramen and nerve root. DOI: Rodway I. This syndrome is characterized by weakness, numbness, tingling, and /or paralysis in both legs. When the L3 spinal nerve is involved, the following symptoms may occur: Sharp pain, typically felt as a shooting and/or burning feeling that may occur in the thigh and/or inner part of the leg. Itchy joints such as the back, chest, or abdomen can be injured as a result of a disc herniation. Treatment options include rest, ice, and pain medication, as well as physical therapy and surgery in severe cases. That is usually the journal article where the information was first stated. The distribution of the L2 spinal nerve is located in the outside thigh. Your pain may worsen with certain activities, like bending, twisting, reaching, coughing, or sneezing. They may also be worse at night or when you bend your knee. 2009 Dec 1;17(1):9. Symptoms of pinched nerves due to foraminal stenosis vary depending on which part of your spine is affected. Weakness while moving the thigh and/or knee in different directions. The vast majority of people with foraminal stenosis will find relief with at-home treatment. Causes and Symptoms of Nerve Encroachment . Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Other symptoms may include difficulty walking or standing, loss of bowel or bladder control, and loss of feeling in the genitals or rectum. When an injury or herniated disk or other problem compresses those nerves, then that causes pain, weakness and incontinence. I love to write and share science related Stuff Here on my Website. It is estimated that between 70% and 83% of herniations are at levels below the L3 threshold. Studies on the effect of acupuncture in people with acute lumbar radicular pain found a positive effect on the pain intensity and pain threshold. Symptoms of a herniated disc can vary depending on the location of the nerve, as nerve pathways are different at each level of the spine. In some cases, low back pain or leg pain that occurs for a few days then goes away is the first indication of a herniated disc. It enlarges the area that the nerve passes through by removing obstructions, like bone spurs, from the foramen. We avoid using tertiary references. Anesthesia & Analgesia. Pain can originate from multiple nerve roots. All rights reserved. For some, the pain can become chronic and/or debilitating. : Read more about Spinal Cord and Spinal Nerve Roots. (2015). Train lumbar multifidus muscle activation in an upright sitting position. Sustain this pose for 10 seconds and then return to the starting position with ten repetitions.Train the muscle co-contraction in a standing position with ankle movement. Nonsurgical treatment is typically recommended first and may include: Medications, like nonsteroidal anti-inflammatory drugs, opioid medicines or muscle relaxants, to manage the symptoms, Weight loss strategies to reduce pressure on the problem area, Physical therapy to strengthen the muscles and prevent further damage, Steroid injections to reduce inflammation and relieve pain. Core stabilisation exercise (CSE) with the abdominal drawing-in manoeuvre (ADIM) technique is commonly used. Clinical presentation for radiculopathy from each lumbar nerve root: Radicular syndrome/ Sciatica:a disorder with radiating pain in one or more lumbar or sacral dermatomes, and can be accompanied by phenomena associated with nerve root tension or neurological deficits. Lumbar Radiculopathy Video. Physical therapy, acupuncture, chiropractic manipulation, and traction are all commonly used in the treatment of lumbosacral radiculopathy. Disc Herniation. and transmitted securely. Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. In the vast majority of cases, the pain eases within six weeks. Dulebohn SC, Ngnitewe Massa R, Mesfin FB. [10]. S1 muscles are thought to be responsible for plantar flexion and, like the gas pedal in a car, contraction. When radiculopathy occurs in the lower back, it is known as lumbar radiculopathy, also referred to as sciatica because nerve roots that make up the sciatic nerve are often involved. A pinched nerve can lead to radiculopathy or pain, numbness, and weakness in the part of the body the nerve serves. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. Symptoms of a lumbar herniated disc can include pain along the nerves of the leg. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. You perform co-contraction of the muscles with trunk forward, backward, and sideways while sitting on a balance board and keeping your lumbar spine and pelvis in a neutral position. Radiculopathy symptoms can often be managed with nonsurgical treatments, but minimally invasive surgery can also help some patients. If one of these nerves become pinched, you may experience: Persistent radiating pain in the abdominal region. Nerve compression syndrome . Pinched nerves in your neck can cause a sharp or burning pain that starts in the neck and travels down your shoulder and arm. Winnie AP, Ramamurthy S, Durrani Z. While the lumbar spinal nerves progressively increase in size, the openings for these nerves (intervertebral foramina) decrease in size from L1 to L5. Herniated Disc If a herniated disk presses on any of the nerves that lead to the groin, the individual may feel pain in the groin as a result of a disc problem in their back. The vast majority of cases are benign and will resolve spontaneously, and thus, conservative management is the most appropriate first step in the absence of clinical red flag symptoms. Many people have no symptoms from a herniated disk. Axons will regenerate about 1mm per day. Symptoms of nerve root impingement vary depending on the location and severity of the condition. The pinched nerve can occur at different areas along the spine (cervical, thoracic or lumbar). Following surgery, patients were evaluated for clinical and radiological conditions, followed up 1, 3, and 12 months later. Bethesda, MD 20894, Web Policies Within each vertebra is a hole in the center (called a foramen), and within each foramen is a type of nervous tissue called a spinal nerve root. Although a sensory disturbance was reported in 9 patients, motor weakness was present in 2. This site is for educational purposes only; no information is intended or implied to be a substitute for professional medical advice. A herniation of the lower back known as sciatica/radiculopathy is a common cause of lower back pain. [2], Radiculopathy is not the same as radicular pain or nerve root pain. In fact, nearly half of all middle-aged and older people have some kind of spinal stenosis and pinched nerves. He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy. What is the mechanism action of H. pylori? doi: 10.1007/s00586-010-1354-5. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459278/ Sciatica is a term you may have heard for this type of pain. This type of pain, which can be constant or intermittent, can be caused by a, Treatment for peripheral artery disease is often a combination of medications and lifestyle changes. BMC Musculoskelet Disord. It is common for a herniated disc to press against, or inflame, a nearby nerve, causing pain to radiate along the length of the nerve. Causes of this type of pain, in the order of prevalence, include: Herniated disc with nerve compression - by far the most common cause of radiculopathy. Your arm and hand may feel weak and numb with pins and needles.. Common patient complaints include pain, numbness, tingling and weakness L5-S1 nerve impingement symptoms An irritated nerve root is often referred to as a burning or sharp pain from the back, which travels to other parts of the body that are linked to the irritated nerve. Lumbar Radiculopathy - Physiopedia I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing.
l2 l3 nerve root impingement symptoms
