Can radiculopathy (inflammation of a nerve root) symptoms disappear in patients with lumbar spondylosis (degenerative joint disease in the lower back)?

From the Guidelines

Radiculopathy symptoms can disappear in patients with lumbar spondylosis, with most patients experiencing improvement within the first 4 weeks with noninvasive management. This is based on moderate-quality evidence from the American College of Physicians and the American Pain Society 1. The natural history of lumbar disc herniation with radiculopathy is for improvement within the first 4 weeks, and there is no compelling evidence that routine imaging affects treatment decisions or improves outcomes.

Some key points to consider in the management of radiculopathy in patients with lumbar spondylosis include:

• Noninvasive management is often effective in improving symptoms, with most patients experiencing significant improvement within 4-6 weeks
• Treatment approaches that help resolve symptoms include anti-inflammatory medications, physical therapy focusing on core strengthening and flexibility exercises, and temporary activity modification to avoid movements that worsen pain
• Some patients may benefit from epidural steroid injections, which deliver anti-inflammatory medication directly to the affected nerve root
• If symptoms persist beyond 3 months or include progressive neurological deficits like worsening weakness or bladder/bowel dysfunction, surgical evaluation may be necessary

It's essential to note that while symptoms can resolve, maintaining good spine health through regular exercise and proper body mechanics is crucial to prevent recurrence. Clinicians should provide patients with evidence-based information on low back pain, advise patients to remain active, and provide information about effective self-care options, as recommended by the American College of Physicians and the American Pain Society 1.

From the Research

Lumbar Spondylosis with Radiculopathy

• Lumbar spondylosis is a chronic, noninflammatory disease caused by degeneration of the lumbar disc and/or facet joints 2.
• Patients with lumbar spondylosis can experience a range of symptoms, including discomfort in the low back and radiating leg pain or neurologenic intermittent claudication (lumbar spinal stenosis) 2.

Radiculopathy Symptoms

• Radiculopathy is a pain syndrome caused by compression/irritation of the lumbar nerve root(s) 3.
• The symptoms of radiculopathy can include pain, disability, and neurological deficits 4, 3, 5.
• The effectiveness of interventions for radiculopathy can differ depending on the stage of the condition (acute, sub-acute, or chronic) 5.

Disappearance of Radiculopathy Symptoms

• There is evidence to suggest that radiculopathy symptoms can improve with conservative management, including physical therapy, exercise, and pain management 4, 3, 5, 2.
• Epidural steroid injections (ESIs) may also be effective in reducing short-term pain and disability in lumbar radiculopathies 6.
• However, the long-term effectiveness of ESIs in reducing pain and disability is less clear, and more research is needed to determine the optimal treatment approach for radiculopathy 6.

Treatment Options

• Conservative management of lumbar radiculopathy can include a range of treatments, such as:
  • Physical therapy and exercise 4, 3, 5
  • Pain management, including nonsteroidal anti-inflammatory drugs and COX-2 inhibitors 2
  • Epidural steroid injections (ESIs) 6
  • Spinal manipulative therapy and functional training 5
• The choice of treatment will depend on the individual patient's needs and the stage of their condition 5.