Lumbar Radiculopathy

Douglas Schottenstein, MD

NY Spine Medicine
Attending Physician
New York Presbyterian
New York, NY

Clinical practice guidelines recommend that clinicians conduct a focused history and physical examination to categorize low back pain into 1 of 3 broad subtypes: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. Assessment of psychosocial risk factors that predict chronic disabling back pain is critical. Patients with lumbar radiculopathy—dysfunction of a nerve root associated with pain, sensory impairment, weakness, or diminished deep tendon reflexes in a nerve root distribution—often present following a traumatic event that results in low back pain and radiating leg pain. An early work-up may include imaging to rule out fracture and potentially identify nerve irritation. Conservative treatment is often preferred early in the course of lumbar radiculopathy, particularly when there is minimal or no sensory/motor involvement; many patients will return to baseline within weeks. Intractable pain may be addressed with opioid and nonopioid medications and office-based interventional procedures, whereas neurologic deficits may prompt a neurosurgical evaluation.

References

Chou R, Loeser JD, Owens DK, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976). 2009;34:1066-1077.
Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12:699-802.
Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

Chronic opioid therapy and preventive services in rural primary care: an Oregon rural practice-based research network study.

Buckley DI, Calvert JF, Lapidus JA, et al.
Ann Fam Med. 2010;8(3):237-44.
PURPOSE:...

A different kind of co-morbidity: Understanding posttraumatic stress disorder and chronic pain

Beck JG, Clapp JD.
Psychol Trauma. 2011 Jun;3(2):101-108.
Many traumatic events leave...

The impact of enrollment in a specialized interdisciplinary neuropathic pain clinic

Garven A, Brady S, Wood S, Hatfield M, Bestard J, Korngut L, Toth C.
Pain Res Manag. 2011...

Association between urine drug test results and treatment outcome in high-risk chronic pain patients on opioids

Barth KS, Becker WC, Wiedemer NL, Mavandadi S, Oslin DW, Meghani SH, Gallagher RM.
J Addict...

The role of core strengthening for chronic low back pain.

Akuthota V, Standaert CJ, Chimes GP.
PM R. 2011 Jul;3(7):664-70.