From the Guidelines
After an MRI for lumbar radiculopathy, the next steps typically involve reviewing the results with your healthcare provider to determine the appropriate treatment plan based on the severity of your condition, as recommended by the American College of Physicians and the American Pain Society 1, 2. The treatment plan should prioritize conservative treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (600-800mg three times daily with food) or naproxen (500mg twice daily with food) for pain and inflammation. Some key points to consider in the treatment plan include:
- Physical therapy focusing on core strengthening, flexibility, and proper body mechanics should be initiated for 6-8 weeks, with sessions 2-3 times weekly.
- Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) may be prescribed for muscle spasms.
- For more severe pain, a short course of oral steroids like prednisone (starting at 60mg daily and tapering over 7-10 days) might be recommended.
- If these conservative measures fail to provide relief after 4-6 weeks, epidural steroid injections may be considered.
- Surgery is typically reserved for cases with progressive neurological deficits, severe pain unresponsive to conservative treatment, or significant functional limitations, as stated in the guidelines 3, 4. These treatments aim to reduce nerve inflammation, alleviate pain, improve function, and prevent recurrence by addressing the underlying compression of nerve roots caused by herniated discs, bone spurs, or spinal stenosis, which is a common cause of lumbar radiculopathy 5, 6. It is essential to note that the natural history of lumbar disc herniation with radiculopathy in most patients is for improvement within the first 4 weeks with noninvasive management 7. Therefore, a conservative treatment approach should be prioritized, and invasive interventions should only be considered if the patient is a potential candidate for surgery or epidural steroid injection, as recommended by the guidelines 1, 2.
From the Research
Next Steps After an MRI for Lumbar Radiculopathy
The next steps after an MRI for lumbar radiculopathy depend on the results of the MRI and the patient's overall condition.
- If the MRI shows a herniated disc or other underlying condition, the patient may be referred to a specialist, such as a neurosurgeon or orthopedic surgeon, for further evaluation and treatment 8.
- The patient may be prescribed medication, such as gabapentin or pregabalin, to manage pain and other symptoms 9.
- Physical therapy may be recommended to help improve mobility and reduce pain 8.
- In some cases, surgery may be necessary to relieve pressure on the nerve root and alleviate symptoms 10.
Diagnostic Tests and Procedures
In addition to an MRI, other diagnostic tests and procedures may be used to evaluate lumbar radiculopathy, including:
- Electromyography (EMG) to assess muscle function and detect any abnormalities in nerve conduction 11, 12.
- Nerve conduction velocity (NCV) tests to measure the speed and strength of electrical signals in the nerves 8.
- Physical examination, including tests such as the Straight Leg Raising (SLR) test and the crossed SLR test, to assess nerve root function and detect any abnormalities 11.
Treatment Options
Treatment options for lumbar radiculopathy depend on the underlying cause and severity of symptoms.
- Conservative management, including medication, physical therapy, and lifestyle modifications, may be recommended for patients with mild to moderate symptoms 8, 9.
- Surgical intervention, such as discectomy or spinal fusion, may be necessary for patients with severe symptoms or those who have not responded to conservative management 10.
- Advanced MRI imaging techniques, such as diffusion-weighted imaging (DWI) and magnetic resonance neurography, may be used to evaluate nerve root function and guide treatment decisions 12.