A Review of Lumbar Radiculopathy, Diagnosis, and Treatment

We review the epidemiology, etiology, symptomatology, clinical presentation, anatomy, pathophysiology, workup, diagnosis, non-surgical and surgical management, postoperative care, outcomes, long-term management, and morbidity of lumbar radiculopathy. We review when outpatient conservative management is appropriate and "red flag" warning symptoms that would necessitate an emergency evaluation. Diagnostic modalities, including magnetic resonance imaging (MRI), computerized tomography (CT), contrast myelogram, electromyogram (EMG), and nerve conduction velocity (NCV), are involved in the diagnosis and decision-making are discussed. Treatment of lumbar radiculopathy requires a multimodal and multispecialty team. We review indications for the involvement of other professionals, including physical therapy (PT), occupational therapy (OT), physical and rehabilitation medicine (PMR), and pain management.

[1]  W. Bernardo,et al.  Lumbar herniated disc - endoscopic discectomy treatment. , 2018, Revista da Associacao Medica Brasileira.

[2]  M. Nordin,et al.  Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration , 2017, European journal of pain.

[3]  Mette Jensen Stochkendahl,et al.  National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy , 2017, European Spine Journal.

[4]  Sangbong Ko,et al.  The Effectiveness of Oral Corticosteroids for Management of Lumbar Radiating Pain: Randomized, Controlled Trial Study , 2016, Clinics in orthopedic surgery.

[5]  E. Pappas,et al.  A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People With Chronic Low Back Pain and a Directional Preference. , 2016, The Journal of orthopaedic and sports physical therapy.

[6]  E. Kogias,et al.  Microendoscopic lumbar discectomy: Technique and results of 188 cases , 2015, Indian journal of orthopaedics.

[7]  E. Benzel,et al.  Optimal Duration of Conservative Management Prior to Surgery for Cervical and Lumbar Radiculopathy: A Literature Review , 2014, Global spine journal.

[8]  Charles H. Cho,et al.  An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. , 2014, The spine journal : official journal of the North American Spine Society.

[9]  S. Hayek,et al.  Minimally invasive lumbar decompression: a treatment for lumbar spinal stenosis , 2013, Current opinion in anaesthesiology.

[10]  F. Ginanneschi,et al.  Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc , 2013, Neurophysiologie Clinique/Clinical Neurophysiology.

[11]  J. Bader,et al.  Characterization of the Incidence and Risk Factors for the Development of Lumbar Radiculopathy , 2012, Journal of spinal disorders & techniques.

[12]  C. Maher,et al.  The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial , 2010, BMC medicine.

[13]  L. Khoo,et al.  Minimally invasive operative management for lumbar spinal stenosis: overview of early and long-term outcomes. , 2007, The Orthopedic clinics of North America.

[14]  Salahadin Abdi,et al.  Epidural steroids in the management of chronic spinal pain: a systematic review. , 2007, Pain physician.

[15]  A. Tarulli,et al.  Lumbosacral radiculopathy. , 2007, Neurologic clinics.

[16]  J. Skinner,et al.  Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. , 2006, JAMA.

[17]  Xiaotao Wu,et al.  Microendoscopic Discectomy for Lumbar Disc Herniation: Surgical Technique and Outcome in 873 Consecutive Cases , 2006, Spine.

[18]  L. Gutmann.  Pearls and Pitfalls in the Use of Electromyography and Nerve Conduction Studies , 2003, Seminars in neurology.

[19]  S. Palmer.  Use of a tubular retractor system in microscopic lumbar discectomy: 1 year prospective results in 135 patients. , 2002, Neurosurgical focus.

[20]  M. Brayda-Bruno,et al.  Posterior endoscopic discectomy (and other procedures) , 2000, European Spine Journal.

[21]  P. Brien,et al.  Herniated lumbar disc. , 1990, Archives of physical medicine and rehabilitation.