Acute lumbosacral radiculopathy: Treatment and prognosis
- 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 (ie, 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 "Acute 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".)
For patients with acute lumbosacral radiculopathy, the objectives of treatment are to ameliorate pain (symptomatic treatment) and to address the specific underlying process (mechanism-specific treatment) if necessary (algorithm 1).
●Neoplastic or infectious etiologies of radiculopathy require prompt mechanism-specific treatment. Though rare, cauda equina syndrome represents a true surgical emergency where decompression should be performed within 24 hours, and within 12 hours if possible. (See "Treatment and prognosis of neoplastic epidural spinal cord compression, including cauda equina syndrome".)
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