Treating lumbar radiculopathy begins with a good understanding of what’s causing the radiculopathy and the anatomy that is involved. Often one of the first approaches is to address the biomechanics – physical therapy. It’s stretching, strengthening, it’s trying to get all the muscles right to help take the pressure off of the spine, off of the hole where the nerve comes out so that the nerves have a chance to heal. When someone’s going to physical therapy there will often be more passive modalities like ultrasound, like electrostimulation, manual manipulation, some traction – all of these different passive modalities, along with others, designed to help also reduce the inflammation around the nerve root.
If the pain is continuing or if the pain is interfering with a person’s ability to do the exercises with physical therapy, then physicians also have different kinds of injections to reduce the inflammation around the nerve root. Essentially what I’m talking about is epidural steroid injections. There are two basic ways of getting medicine into the epidural space for this kind of a problem. One is coming from behind the disc and the nerve root and one is more of a transforaminal approach. Here’s a spine and here’s where nerves exit the spine on the side. You can either come with a needle and you can put medicine right next to the nerve root as the nerve exits the spine or you can come from behind it in a couple of different ways in order to basically get some steroid around the nerve root.
Now, an epidural steroid injection is not going to change the arthritis that may be leading to radiculopathy. It’s not going to change a herniated disc. It’s not going to mask anything either. What it’s going to do is it’s going to reset the inflammatory clock back down to zero or close to zero. What this does is it allows the patient to, ideally, do more with physical therapy to take advantage of a window of opportunity during which they can do more stretching, do more strengthening and this can help tweak the biomechanics so we’re not sitting back there in 3 months/6 months/1 year having to repeat those kinds of injections.
Oral medications can also be helpful to control the symptoms while a patient is going through physical therapy, stretching, strengthening, giving it some time in order to allow the nerve to heal. When more conservative measures aren’t effective – in those relatively rare instances – there are surgical alternatives, depending on the underlying anatomy. Sometimes a surgery can be as simple as a discectomy to take out a piece of the disc and sometimes, depending on the pathophysiologic processes going on in the spine, the surgery may have to be more involved.