Lumbar Radiculopathy Diagnosis and Management

Clinical Presentation

A 55-year-old female presents with low back pain radiating down the left leg, consistent with lumbar radiculopathy, and has failed a trial of ibuprofen for pain relief, according to the American Academy of Family Physicians 1
The patient's past medical history is significant for diverticulitis, which is not relevant to this presentation unless she develops concurrent left lower quadrant pain, fever, or gastrointestinal symptoms, as noted by the Journal of the American College of Radiology 2

The American College of Radiology recommends MRI of the lumbosacral spine without contrast as the preferred initial imaging study for evaluating radicular symptoms with suspected nerve root compression, with a focus on identifying nerve root compression and assessing for cauda equina syndrome 2
Laboratory studies, including complete blood count with differential, erythrocyte sedimentation rate, and C-reactive protein, may be considered if infection or inflammatory process is suspected, as suggested by the American Academy of Family Physicians 1

The American Academy of Family Physicians recommends considering a short course of oral corticosteroids, such as methylprednisolone, for acute radiculopathy, and adding a neuropathic pain agent, such as gabapentin or pregabalin, for pain management 1
Early physical therapy, focusing on core strengthening and nerve gliding exercises, is recommended to improve outcomes in radiculopathy, according to the American Academy of Family Physicians 1
Specialist referral is indicated if progressive neurologic deficits develop, cauda equina syndrome is suspected, or severe, disabling pain persists despite 6 weeks of conservative management, as noted by the American Academy of Family Physicians 1

A high-quality diet rich in fruits, vegetables, whole grains, and legumes, maintaining a normal BMI through diet and exercise, and regular physical activity are recommended to reduce the risk of diverticulitis, as suggested by the American Academy of Family Physicians 1
Smoking cessation is also recommended, if applicable, to reduce the risk of diverticulitis, according to the American Academy of Family Physicians 1