Overview
What is the correlation between lumbosacral radiculopathy and low back pain?
What causes lumbosacral radiculopathy?
What is the prevalence of lumbosacral radiculopathy in the US?
What anatomy is relevant to lumbosacral radiculopathy?
What is the role of herniation of the intervertebral disc in lumbosacral radiculopathy?
What is the role of inflammatory mechanisms in the pathophysiology of lumbosacral radiculopathy?
What is the role of hydraulic pressure in the pathophysiology of lumbosacral radiculopathy?
Why are dancers prone to lumbosacral radiculopathy?
Why are golfers and competitive weightlifters prone to lumbosacral radiculopathy?
Presentation
What are the initial symptoms of lumbosacral radiculopathy?
Which activities may exacerbate the pain of lumbosacral radiculopathy?
What are the symptoms of roots L1-L3 lumbosacral radiculopathy?
What should be the focus of history for lumbosacral radiculopathy?
What should be included in the physical exam for acute lumbosacral radiculopathy?
What should be included in the neurologic exam for lumbosacral radiculopathy?
How is L3 lumbosacral radiculopathy differentiated from femoral neuropathy?
What is the role of provocative maneuvers in the physical exam of lumbosacral radiculopathy?
What should be included in the musculoskeletal evaluation of lumbosacral radiculopathy?
DDX
What are the differential diagnoses for Lumbosacral Radiculopathy?
Workup
What is the role of imaging in the workup of lumbosacral radiculopathy?
What is the role of plain radiographs in the workup of lumbosacral radiculopathy?
What improves the usefulness of plain radiographs in the evaluation of lumbosacral radiculopathy?
What is the role of MRI in the workup of lumbosacral radiculopathy?
What are the indications for MRI in the workup of lumbosacral radiculopathy?
What is the role of CT scanning in the workup of lumbosacral radiculopathy?
What is the role of myelogram in the workup of lumbosacral radiculopathy?
When are myelograms indicated in the workup of lumbosacral radiculopathy?
What is the role of discography studies in the workup of lumbosacral radiculopathy?
What does a positive discogram for lumbosacral radiculopathy include?
When is a discography indicated in the workup of lumbosacral radiculopathy?
What is the role of electrodiagnostic studies in the workup of lumbosacral radiculopathy?
What are the benefits of electrodiagnostic studies in the workup of lumbosacral radiculopathy?
What are the disadvantages of electrodiagnostic testing in the workup of lumbosacral radiculopathy?
When should electrodiagnostic test for lumbosacral radiculopathy be performed?
Which electrodiagnostic studies are performed in the evaluation of lumbosacral radiculopathy?
What procedures are used in the workup of lumbosacral radiculopathy?
Treatment
What is the "back school" method of physical therapy for lumbosacral radiculopathy?
What is the role of core strengthening in the treatment of lumbosacral radiculopathy?
Which soft tissue PT modalities used in the treatment of lumbosacral radiculopathy?
What is the role of lumbar traction in the treatment of lumbosacral radiculopathy?
What are the surgical options for lumbosacral radiculopathy?
What is the efficacy of surgery in the treatment of lumbosacral radiculopathy?
What is the role of epidural steroid injections in the workup of lumbosacral radiculopathy?
What is the efficacy of epidural steroid injections to treat lumbosacral radiculopathy?
What is the role of trigger point therapy in the treatment of lumbosacral radiculopathy?
How should patients with lumbosacral radiculopathy progress in the recovery phase?
What is the role of manual medicine treatment for lumbosacral radiculopathy?
Medications
What is the role of NSAIDs in the treatment of lumbosacral radiculopathy?
What is the role of muscle relaxant drugs in the treatment of lumbosacral radiculopathy?
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Sagittal magnetic resonance image showing loss of intervertebral disc height at L5/S1. Herniations of the nucleus pulposus are noted at L4/5 and L5/S1. Courtesy of Barton Branstetter, MD.
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Discogram showing examples of an intact disc and a disrupted disc at the lumbar level.
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Magnetic resonance image demonstrating extension of the nucleus pulposus to the right paracentral region of the spinal cord. The disc is adjacent to the inflamed right L5 nerve root. Courtesy of Barton Branstetter, MD.