Lumbosacral radiculopathy: Mgmt
Last updated: 03/05/2015
Conservative treatment is appropriate for most patients.This may include anti-inflammatory medications, physical therapy or chiropractic treatment, and avoiding activity that strains the neck or back. The majority of radiculopathy patients respond well to this conservative treatment, and symptoms often improve within 6 weeks to 3 months.
Oxycodone, or oxycodeone with acetaminophen (Percocet) are often prescribed for relief of moderate to severe pain. Opioids are not always effective for pain generated by compressed nerves (radiculopathy, neuropathy).
If patients do not improve with the treatments listed above they may benefit from an epidural steroid injection. Often performed under fluoroscopy, a physician injects steroid medication into the epidural space adjacent to the involved nerves. This can help to rapidly reduce the inflammation and irritation of the nerve and help reduce the symptoms of radiculopathy. While the short term benefit of epidural steroids is well-documented, their long term efficacy is controversial.
If the above treatments are unsuccessful, and the symptoms remain severe, surgical intervention may be necessary. Surgical intervention is focused on removing compressive effects on the nerve effected. Depending on the cause of the radiculopathy, this can be done by a laminectomy or a discectomy. A laminectomy removes a small portion of the bone covering the nerve to allow it to have additional space. A discectomy removes the portion of the disc that has herniated out and is compressing a nerve.
- S E Abram Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology: 1999, 91(6);1937-41 PubMed Link
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