What is the treatment for lumbar radiculitis?

Treatment for Lumbar Radiculitis

The treatment of lumbar radiculitis should follow a stepped care approach, beginning with conservative management and progressing to more invasive interventions only when necessary, with early assessment and stratification of patients to allocate appropriate resources based on symptom severity.1

Initial Management

• Most patients with lumbar disc herniation and radiculopathy will experience improvement within the first 4 weeks with noninvasive management 1
• Patients should be advised to remain active rather than rest in bed, as this is more effective for acute or subacute low back pain 1
• If bed rest is required for severe symptoms, patients should be encouraged to return to normal activities as soon as possible 1
• Self-care education based on evidence-based guidelines should be provided to supplement clinician advice 1

Conservative Treatment Options

Physical Therapy and Exercise

• Supervised exercise programs or formal home exercise regimens targeting strength, flexibility, and general physical fitness should be incorporated into treatment 1
• For patients with foot drop and acute lumbar radiculitis, therapeutic stretching combined with trigger point treatments may be beneficial 2

Pharmacological Management

• Opioids should be used with tight restrictions - at the lowest possible dose for the shortest time possible with close monitoring of efficacy and side effects 1
• The use of opioids in managing low back pain is controversial due to lack of evidence for long-term benefit 1

External Bracing

• External brace immobilization (thoracolumbosacral orthosis brace) can help diminish pain and immobilize the involved segment during concurrent medical therapy 1
• This option is suitable for patients with isolated discitis and pain only 1

Interventional Procedures

Epidural Steroid Injections

• For patients with persistent radicular symptoms despite noninvasive therapy, epidural steroid injections are a potential treatment option 1
• Image-guided steroid injections should be considered for severe radicular pain (disabling, intrusive pain that prevents normal everyday tasks) 1
• Fluoroscopic guidance is considered the gold standard for targeted interlaminar epidural or transforaminal epidural steroid injections 1
• Research shows that both local anesthetic alone and local anesthetic with steroids can be effective in managing chronic low back and lower extremity pain in patients with disc herniation and radiculitis 3, 4

Radiofrequency Ablation

• Conventional (80°C) or thermal (67°C) radiofrequency ablation of the medial branch nerves should be performed for low back pain when previous diagnostic or therapeutic injections have provided temporary relief 1
• Conventional or thermal radiofrequency ablation of the dorsal root ganglion should not be routinely used for lumbar radicular pain 1

Surgical Management

Discectomy

• For prolapsed lumbar disc with persistent radicular symptoms despite noninvasive therapy, discectomy is a potential treatment option 1
• Reoperative discectomy is recommended as a treatment option in patients with recurrent lumbar disc herniation 1

Fusion Procedures

• Lumbar spinal fusion is not recommended as routine treatment following primary disc excision in patients with herniated lumbar disc causing radiculopathy 1
• Fusion should be considered as a potential surgical adjunct in patients with:
  • Evidence of preoperative lumbar spinal deformity or instability 1
  • Significant chronic axial low-back pain associated with radiculopathy due to herniated lumbar disc 1
  • Recurrent disc herniation associated with lumbar instability, deformity, or chronic axial low-back pain 1

Timing of Referral and Imaging

• Patients with severe radicular pain or neurological deficit should be referred to specialist services within 2 weeks of presentation 1
• Patients with less severe radicular pain should be referred to specialist services for assessment and management no later than 3 months (earlier if pain is severe) 1
• MRI (preferred) or CT is recommended for evaluating patients with persistent back and leg pain who are potential candidates for surgery or epidural steroid injection 1
• Imaging should be requested by clinicians able to interpret the images and act on them 1

Important Considerations

• Findings on MRI or CT (such as bulging disc without nerve root impingement) are often nonspecific and should be correlated clinically with symptoms 1
• Decisions regarding specific invasive interventions should be based on clinical correlation between symptoms and radiographic findings, symptom severity, patient preferences, surgical risks, and costs 1
• Early, routine imaging does not improve patient outcomes and incurs additional expenses 1
• The treatment approach should be adjusted based on patient response, with close monitoring and follow-up to ensure optimal outcomes 1