Care Pathway for the Management of Lumbar Disc Herniation with Radiculopathy

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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.

No

No

No

Yes

Are symptoms ≤3 months?

Yes

Management of Symptoms

 

Based on shared decision making between the patient and provider, any one of the following therapeutic interventions is recommended:

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Yes

Yes

No

No

Discharge

Are symptoms >3 months?

Yes

Yes

Yes

Discharge

No