Lumbar Pain Maps
Lumbar Facet Joints
From Manchikanti
Unable to access full text of Fukui 1997
Lumbar Discs
I could not find any useful pain maps for lumbar discs
Soft Tissues
Kellgren (Interspinous Ligaments)
-
Pain arising from noxious injection of interspinous ligaments T2 to L2 -
Pain arising from noxious injection of interspinous ligaments T3 to S1
Feinstein ("Musculotendinous Interspinous Tissues")
This seems to be the paramedian interspinous tissues.
Lumbar Radicular Pain
- Main article: Lumbar Radicular Pain
Sensory Deficit Maps with Nerve Block
In 1993 Nitta et al looked at dermatome patterns by doing fluoroscopically guided spinal nerve anaesthetic blocks in patients with radicular pain. They found the following sensory deficits.[1]
-
L4 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the lateral and anterior side of the thigh and the medial side of the leg to the first digit of the foot. -
L5 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the posterior, lateral aspect of the thigh and leg, to the 5th digit of the foot. -
S1 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the lateral side of the thigh, the lateral side of the leg, and the medial side of the dorsum of the foot to the first digit. -
Distinctive regions. L4 is medial side of the lower leg in 88%. L5 is first dorsal digit in 82%. S1 is lateral side of 5th digit in 83%. -
Proportion having band like deficits.
Inadvertent Pain Maps during TFI
Furman et al in 2019 mapped lower limb radicular symptoms based on inadvertent pain patterns during supraneural transforaminal injections, the data is modified in table format below. They confirmed that history and pain charts cannot predict the nerve root level. The buttock is a very common pain referral location across all nerve roots, while pain in the thigh and leg frequently follows dermatomal distributions. A significant limitation of the study is that injectate in transforaminal injections frequently traverses segment levels.[2]
| Nerve Root | L3 | L4 | L5 | S1 |
|---|---|---|---|---|
| Buttock | 45% | 43% | 62% | 64% |
| Groin | 0% | 3% | 0% | 0% |
| Anterior Thigh | 27% | 29% | 12% | 0% |
| Posterior Thigh | 36% | 25% | 59% | 36% |
| Medial Thigh | 18% | 11% | 3% | 0% |
| Lateral Thigh | 0% | 14% | 9% | 0% |
| Knee | 9% | 7% | 6% | 9% |
| Anterior Leg | 0% | 14% | 3% | 0% |
| Posterior Leg | 18% | 18% | 50% | 45% |
| Medial Leg | 0% | 7% | 6% | 0% |
| Lateral Leg | 9% | 14% | 24% | 0% |
| Foot | 0% | 3% | 0% | 0% |
Lumbar Spinal Stenosis Pain
Young et al
These pain patterns were taken from patients with lumbar spinal stenosis seen in a secondary spine centre. They are not validated against diagnostic and treatment outcomes. They just required a diagnostic code indicating lumbar spinal stenosis. They identified six clinical pain patterns. [3]
- Class 1 (11.4%) represented a bilateral posterior leg pain distribution pattern
- Class 2 (8.7%) bilateral posterior and anterior leg pain
- Class 3 (26.1%) unilateral posterior leg pain
- Class 4 (21.0%) unilateral posterior leg pain with low back pain
- Class 5 (22.9%) unilateral anterior and posterior leg pain
- Class 6 (9.9%) multisite pain.
See Also
References
- ā Nitta et al.. Study on dermatomes by means of selective lumbar spinal nerve block. Spine 1993. 18:1782-6. PMID: 8235861. DOI.
- ā Furman & Johnson. Induced lumbosacral radicular symptom referral patterns: a descriptive study. The spine journal : official journal of the North American Spine Society 2019. 19:163-170. PMID: 29800710. DOI.
- ā Young, James J; Chang, Natalie Hong Siu; Nim, Casper; OĀ“Neill, SĆøren; McNaughton, David T; Jensen, Rikke KrĆ¼ger; Harsted, Steen (2025-08-02). "Digital pain diagrams to identify common lumbar spinal stenosis pain distribution patterns: a cross-sectional latent class analysis". European Spine Journal (in English). doi:10.1007/s00586-025-09218-9. ISSN 1432-0932.
