• Hiroki Hirabayashi, Jun Takahashi, Hiroyuki Hashidate, Nobuhide Ogihara, Atsutoshi Tashiro, Hiromichi Misawa, Sohei Ebara, Katsuhiro Mitsui, Shinji Wakabayashi, and Hiroyuki Kato.
• Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan.
• Surg Neurol. 2009 Jul 1;72(1):36-40; discussion 40.

BackgroundIn degenerative lumbar spinal disease with nerve root compression, the L5 and S1 nerve roots are the most often affected and the L3 nerve root is involved infrequently. The purpose of this study was to investigate the characteristics of L3 nerve root radiculopathy.MethodsSeventeen consecutive patients with L3 radiculopathy were treated. The symptomatic nerve roots were determined by the pain distribution, the neurologic findings, and selective nerve root injection. The clinical characteristics and outcomes of these patients were assessed retrospectively.ResultsThe average age was 76 years. 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. The patients' symptoms were thigh pain in 12 patients, and hip or knee pain in 5. Four patients were nonambulatory because of severe pain. Although a sensory disturbance was reported in 9 patients, motor weakness was present in 2. Selective nerve root injection was completely effective in 10 patients. Six had decompressive surgery and/or fusion followed by a favorable outcome. Four patients were misdiagnosed and received conservative treatment for hip and/or knee joint diseases.ConclusionsL3 radiculopathy was characterized by various lower limb pain and neurologic deficit. Selective nerve root injection was effective for most patients. 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.

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