Lumbar Neuritis: Types, Causes, Symptoms, Signs, Treatment- Conservative, PT, Surgery

Lumbar neuritis is an inflammation of the lumbar nerves branched out from spinal cord at lumbar division. Lumbar nerve is a peripheral nerve. There are 5 lumbar nerves identified as L1, L2, L3, L4 and L5. L stands for lumbar segment. Lumbar nerve carries sensory and motor impulses (messages). Peripheral nerve fiber lies outside central nervous system and spinal cord. Lumbar neuritis is a disease caused by inflammation of peripheral lumbar nerves fibers. Lumbar neuritis is a segmental inflammatory disease of lumbar nerve fibers.

Lumbar Neuritis

Impulse (Messages) Transmission Through Lumbar Nerve-

Sensory Impulses (Massages) are Transmitted as Follows-

Sensory impulses from peripheral tissue and organs are transmitted to spinal cord.

Motor Impulses (Massages) are Transmitted as Follows-

Motor impulses are transmitted to muscles from spinal cord.

Lumbar Nerve Fibers

  • Lumbar sensory nerve fibers carry sensory information from peripheral tissue (skin, subcutaneous tissue and muscles) and viscera (tubular organs like stomach, intestine, kidney etc.) to spinal cord.
  • Lumbar motor nerve fibers carry information from spinal cord to skeletal and smooth muscles. Skeletal muscles are muscles of lower extremities and back.
  • Sensory information affected by lumbar neuritis is touch, temperature, pressure and position of lower extremity.

Types of Lumbar Neuritis

Lumbar Neuritis is Classified as Mono Neuritis or Polyneuritis:

a. Lumbar Mono-Neuritis

  • Lumbar Sensory Nerve- Affects single sensory fiber and results in abnormal sensory symptoms like pain, tingling and numbness spread over lower extremity and lower back.
  • Lumbar Motor Nerve- Affects single motor nerve and results in symptoms of motor deficit such as weakness and atrophy of muscles of lower extremity and lower back.

b. Lumbar Polyneuritis

  • Lumbar Sensory Nerve inflammation- Affects several lumbar sensory nerves fibers from level L1 to L5. Sensory deficit is often wide spread in lower extremity.
  • Lumbar Motor Nerve inflammation- Affects motor fibers of single or multiple segments and results in wide spread motor deficits resulting in weakness and atrophy of affected muscles.

c. Mixed Nerve

Lumbar Sensory and Motor Nerve Inflammation- Affects sensory and motor nerve on one or several lumbar segments. The inflammatory diseases are described as mixed neuritis or sensory and motor nerve neuritis.

Causes of Lumbar Neuritis

A. Lumbar Neuritis in Epidural Space

B. Lumbar Neuritis in Foraminal Space

Prostaglandin- Secreted by disc bulge or herniated disc.

C. Lumbar Neuritis in Lumbar Plexus

  • Retroperitoneal Tumor
  • Retroperitoneal Abscess
  • Psoas Abscess
  • Retroperitoneal Hematoma

D. Lumbar Neuritis Due to Lumbar Peripheral Nerves

a. Nerve Laceration– Caused by accident and injury e.g. auto accident, work accident, penetrating injury

b. Nerve Tear– Caused by penetrating injury following domestic fall, auto or work accident.

c. Tumor or Cancer Pressing On Nerve– Benign or malignant retroperitoneal cancer or bone metastasis exerts pressure on nerve as the tumor mass grows. Malignant cancer grows faster than benign. Symptoms become rapid and worse when malignant cancer is involved.

d. Scar Tissue– Scar tissue is thick bundle of fibrous tissue. Peripheral lumbar nerve may be pinched within scar tissue resulting in severe pain, numbness or weakness in muscles.

e. Diet and Vitamin Deficiency– Vitamin deficiency causes peripheral neuritis and results in neuropathy. Following vitamin deficiency causes peripheral neuritis

  • B vitamins
  • Beriberi (deficiency in thiamine) and
  • Pellagra (deficiency in niacin).

f. Alcohol Induced Neuritis

Causes B12 deficiency and results in neuritis.

g. Infections and Toxins Causing Lumbar Neuritis-

  • Diphtheria toxins
  • HIV results in AIDS
  • Hepatitis

h. Chemical Poisoning Causes Lumbar Neuritis-

  • Lead
  • Mercury
  • Benzine
  • Carbon disulfide
  • Nitrous oxide
  • Monosodium methanearsonate

i. Endocrinal Disease- Endocrinal disease causes neuritis and later results in neuropathy secondary to degenerative changes of the nerve.

j. Side Effects of Medication Results in Lumbar Neuritis-

  • Over-the-counter medications
  • Herbal or alternative treatments
  • Cytarabine Hydrochloride
  • Cytosar-U
  • Amlodipine and Benazepril
  • Lotrel

Symptoms and Signs of Lumbar Neuritis

Symptoms of Lumbar Neuritis

Pain and Tenderness-

  • Chronic Pain– Pain is often observed along the single nerve or multiple nerves.
  • Neuropathic Pain– Patient may complain of allodynia or hyperalgesia.
  • Burning Pain– Burning pain often not responding to pain medication.
  • Pain At Night– Observed in polyneuritis. Pain wakes up the patient and patient is unable to sleep.


Pain may be associated with tingling and suggests early signs of nerve damage.


  • Numbness suggests nerve is permanently damaged or severely damaged.
  • Numbness is reversible if treated promptly.

Temperature Changes-

Mostly observed in lumbar polyneuritis. Patient is unable to recognize high or low temperature when cold or warm object is in contact with skin involved in polyneuritis.

Touch and Pressure-

  • Patient is unable to recognize high or low pressure sensations.
  • Unable to differentiate simple touch over affected skin.

Signs of Lumbar Neuritis

Muscle Weakness and Strength-

  • Patient is often unable to lift leg against gravity when group of muscles are affected.
  • Weakness is noticed when individual muscles are tested.
  • Muscle strength is examined as muscle tone and power. Muscle strength is reduced in lumbar neuritis.

Muscle Tone-

  • Muscle tone is reduced.
  • Examination of individual muscle indicates muscle mass is smaller then normal leg when motor nerve is inflamed.


Coordination involves multiple muscles and joint. Rarely in mono-neuritis coordination is found abnormal. Coordination is abnormal in polyneuritis.


Reflexes involves multiple nerve and abnormal in polyneuritis.

Investigations and Lab Studies to Diagnose Lumbar Neuritis

  • White Blood Cell (WBC) Count– Increased when neuritis is caused by infection like diphtheria
  • Electromyogram (EMG)– evaluate abnormal nerve function and conduction.
  • X-Ray– Evaluate cause of neuritis like spinal stenosis, osteophytes and foraminal stenosis
  • MRI– Evaluate bulge disc, herniated disc, cancer growth and vascular disease like aneurysm causing pressure on nerve.
  • Nerve Conduction Tests– Evaluate sensory or motor nerve abnormalities.
  • Nerve Biopssy– Nerve biopsy is to rule out cause of pain such as neuropathy.

Treatment Options for Lumbar Neuritis

Conservative Treatment Approach For Lumbar Neuritis

Vitamin Supplements-

Vitamin B12 or combination of B1, B2 B6 and B12 prescribed for 4 to 6 weeks or longer.


Vegetables like carrots, beet, citrus fruits, apples, and pineapples provide vitamin and minerals.


  • Zanthoxylum clava-herculis (Toothache Tree)
  • Matricaria recutita (German Chamomile, Harpagophytum procumbens (Devil’s Claw) prescribed as anti-inflammatory medications.
  • Arctium lappa (Burdock)- prescribed as analgesics.


Rest is advised until inflammation is adequately treated.

Physical Therapy (PT) For Lumbar Neuritis

Physical Therapy (PT) Improves Pain Tolerance-

Physical therapy helps to improve pain tolerance

Physical Therapy (PT) Improves Muscle Strength-

  • Prevents muscle weakness, which often follows inactive life style because of pain.
  • Prevent atrophy and weakness of leg and thigh muscles.
  • Patient is encouraged to move knee joint, hip joint and toes.

Physical Therapy (PT) Improves Joint Movement-

  • Chronic pain, numbness and weakness restricts joint movement, which is followed by joint stiffness.
  • Physical therapy helps to maintain normal joint movement.

Medication Treatment for Lumbar Neuritis

Non-Steroid Anti-inflammatory Medications To Treat Lumbar Neuritis:

  • Prescribed as anti-inflammatory to treat neuritis.
  • Prescribed as an analgesic (pain relief) instead opioids.
  • Example- Motrin, Naproxen and Celebrex.

Opioid Medications For Lumbar Neuritis-

  • Prescribed for acute nociceptive pain.
  • Pain is treated with short acting opioids.
  • Opioids used as analgesics are Vicodine, Norco or Loratab.

Muscle Relaxants For Lumbar Neuritis-

Prescribed for-

  • Muscle spasm
  • Muscle pain
  • Prior to physical therapy
  • Example- Baclofen, Skelaxin, Relaxin and Flexeril.

Anti-epileptic Analgesics for Lumbar Neuritis:

Prescribed for

  • Neuropathic burning pain caused by neuritis.
  • Example- Neurontin and Lyrica.

Anti-depressant Analgesics for Lumbar Neuritis

Prescribed for-

  • Neuropathic burning pain caused by neuritis.
  • Example- Elavil, Savella and Cymbalta.

Interventional Therapy for Lumbar Neuritis

Peripheral Lumbar Nerve Block Therapy for Lumbar Neuritis

  • Pinch Nerve Entrap In Scar Tissue- Treated with Cortisone Injection over the scar tissue. Cortisone softens scar tissue and releases pressure resulting in pain relief. Injection may have to be repeated every 2 to 6 weeks for 6 to 12 months.
  • Lacerated or torn nerve causes phantom and neuropathic pain. Pain is treated with local anesthetics and corticosteroid.

Trans-Foraminal Epidural Steroid Injection for Lumbar Neuritis

  • Trans epidural injection is performed for lumbar neuritis caused by foraminal stenosis.
  • Trans-foraminal epidural injection works as selective nerve block as well as unilateral or bilateral epidural injection.
  • Injection is repeated 3 times in first 6 weeks and then every 3 to 6 months as necessary.

Epidural Steroid Injection for Lumbar Neuritis

  • Epidural injection is performed by inserting needle in epidural space using midline approach.
  • Medications spread bilaterally and in multiple segments.
  • Injection is repeated like transforaminal epidural 3 times in first 6 weeks and then every 3 to 6 months as necessary.

Neuromodulation Therapy for Lumbar Neuritis

  • Neuromodulation is indicated when all other treatment including surgery has failed to relieve pain.
  • Neuromodulation is also treatment of choice if surgery is not a choice of treatment and all other treatment has failed to relieve pain.
  • Neuromodulatuon therapy involves trial and permanent placement of spinal cord stimulator and generator.

Surgical Treatment for Lumbar Neuritis

Scar Tissue Removal Treatment for Lumbar Neuritis

  • Removal of scar tissue is a rare surgery since scar tissue often redevelops and recurrence of symptom is common.
  • Entrapped nerve within scar tissue after fracture or dislocation is often treated with surgery.
  • Patient should consult an experienced surgeon to evaluate and diagnose the cause of neuritis.

Nerve Repositioning Treatment for Lumbar Neuritis

  • Repositioning the nerve is often attempted to free the nerve from irritation.
  • Repositioning of major nerve relieves pain caused by irritation or bony prominence following fracture or dislocation.

Retroperitoneal Tissue Removal Treatment for Lumbar Neuritis

  • Lumbar nerve is irritated or pinched in retroperitoneal tissue. Cause may be psoas abscess or retroperitoneal abscess and retroperitoneal tumor.
  • The cause is removed by surgery.

Discectomy or Laminectomy Surgery for Lumbar Neuritis

Indications for Discectomy-

  • Bulge disc
  • Herniation of disc or herniated nucleus pulposus.

Indications of Laminectomy-

  • Bulge Disc
  • Disc Herniation
  • Spinal Stenosis
  • Foraminal Stenosis
  • Osteophyte in Spinal Canal or Foramina

Spinal Fusion Surgery for Lumbar Neuritis

Indications for Spinal Fusion Surgery-

  • Spinal Stenosis
  • Foraminal Stenosis
  • Osteophyte in Spinal Canal or Foramina
  • Failed Discectomy.
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 20, 2018

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