Care Pathway for the Management of Lumbar Disc Herniation with Radiculopathy


Risk factors/red flags may include:

  • cancer (history of cancer, unexplained weight loss, nocturnal pain age >50)

  • vertebral infection (fever, intravenous drug use, recent infection)

  • cauda equina syndrome (urinary retention, motor deficits at multiple levels, fecal incontinence, saddle anesthesia)

  • osteoporotic fractures (history of osteoporosis, use of corticosteroid, older age)

  • ankylosing spondylitis (morning stiffness, improvement with exercise, alternating buttock pain, awakening due to back pain during the recond part of the night. younger age)

  • imflammatory arthritis (morning stiffness, swelling in multiple joints)

Conduct an appropriate clinical evaluation to rule out major structural or other pathologies as the cause of the symptoms.

This list of risk factors of serious pathology was adapted from Chou et al. Diagnosis of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147:478-491.