from: nerve root compression

Evaluation and treatment of nerve root compression

(NEJM 2016;374:1763)

• MRI if sx not improved after 6 wk of conservative tx; if nondiagnostic, consider EMG/NCS

• Conservative therapy of nerve root compression

• Avoid opiates when possible; risks outweigh benefits in noncancerous back pain

• Spinal epidural steroid injections (ESI): limited short-term relief of refractory radicular pain

• Surgery: cord compression or cauda equina syndrome; progressive motor dysfunction/EMG/NCS pathologic findings; bowel/bladder dysfunction; intractable pain w/ failure to respond to conservative Rx after 3 mo