Acute lumbosacral radiculopathy: Prognosis and treatment
- Kerry Levin, MD
Kerry Levin, MD
- Chairman, Department of Neurology
- Cleveland Clinic
- Cleveland Clinic Lerner College of Medicine
- Philip S Hsu, MD
Philip S Hsu, MD
- Assistant Professor
- Tufts University School of Medicine
- Carmel Armon, MD, MHS
Carmel Armon, MD, MHS
- Chairman, Department of Neurology
- Assaf Harofeh Medical Center
- Associate Clinical Professor of Neurology
- Tel Aviv University Sackler School of Medicine
Lumbosacral radiculopathy is a condition in which a disease process affects the function of one or more lumbosacral nerve roots. The most common cause is structural — disc herniation or degenerative spinal stenosis — leading to root compression.
This topic will review the prognosis and treatment of lumbosacral radiculopathy, focusing on the acute period (up to four weeks). Other clinical aspects of lumbosacral radiculopathy and the management of lumbar spinal stenosis are discussed separately. (See "Lumbosacral radiculopathy: Pathophysiology, clinical features, and diagnosis" and "Lumbar spinal stenosis: Treatment and prognosis".)
The management of subacute and chronic low back pain is reviewed elsewhere. (See "Subacute and chronic low back pain: Nonsurgical interventional treatment" and "Subacute and chronic low back pain: Pharmacologic and noninterventional treatment" and "Subacute and chronic low back pain: Surgical treatment".)
While acute lumbosacral radiculopathy is often extremely painful, the likelihood of spontaneous improvement is thought to be high when the cause is disc herniation or lumbar spinal stenosis due to degenerative arthritis. However, natural history data for lumbosacral radiculopathy are limited.
Some insight can be gained from placebo arms of randomized trials. In this regard, a trial of 208 patients with acute L5 and/or S1 radiculopathy found no significant difference in outcome for those assigned to nonsteroidal antiinflammatory treatment or to placebo at four weeks, and most patients had a satisfactory recovery . At three months, approximately 30 percent of patients in both groups still had complaints of back pain.
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