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Abstract
The primary purpose of this literature review is to determine if descriptions of the quality of lower extremity pain originating in the lumbar spine can reliably be used to identify potential structures at fault. The secondary purpose of this review is to determine if the segmental level of the spine can be identified based on the location of the pain in the lower extremity in circumstances where the lower extremity pain is of lumbar spine origin. A literature review revealed that somatic structures from the lumbar spine can refer pain into the lower extremities. The quality of somatic referred pain is most commonly perceived as deep, achy, diffuse, and poorly localized. Somatic structures of the lumbar spine do not refer pain consistently in a segmental pattern into the lower extremity, and the concept of sclerotomes is not supported in the current literature. Radicular pain is described as intense, radiating, severe, sharp, darting, lancinating, and well localized. It is generally accepted that radicular pain from L5 and S1 consistently follows a dermatomal pattern into the lower extremity most of the time, especially if the pain extends past the ankle. It is difficult to distinguish between L5 and S1 radicular pain patterns above the ankle. More research is needed in order to draw conclusions concerning the L1-L4 and S2 nerve roots as to whether or not they consistently cause radicular pain into their respective dermatomes. It appears, based on the literature, one cannot develop a reliable, consistent initial hypothesis of which somatic structure(s) (ligaments, vertebrae, dura, musculature, zygoapophyseal joints, or intervertebral discs) may be at fault based on the description of the pain; however, the quality of the pain may assist the clinician in hypothesizing whether the patient's problems are predominantly somatic in origin, of nerve root origin, or a combination of both. Based on the literature, one cannot identify what segmental level of the spine may be involved based on the location of the pain if the pain is somatic in origin. However, for radicular pain, the pattern will more likely follow a dermatome if it is caused by a L5 or S1 nerve root.