1. Lumbosacral radicular pain

Abstract

IntroductionPatients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%.MethodsThe literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized.ResultsAlthough a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s).In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short‐term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well‐selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers.ConclusionsThe diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.

Efficacy of epidural steroid injection in the treatment of sciatica secondary to lumbar disc herniation: a systematic review and meta-analysis

“…In this study, the administration mode was described in detail. In terms of the proportion of patients with pain relief, the parasaggital interlaminar route had the best effect, followed by the caudal injection and interlaminar route, and the transforaminal approach had the worst effect, which was slightly inconsistent with the results of previous study ( 18 ). However, due to the small number of studies included in this study and the large differences in the proportion and component of drugs, this conclusion is not highly reliable.…”

“…In 2022, a meta-analysis of 25 RCTs found that steroid treatment was superior to local anesthesia or placebo in improving outcomes at 1 and 3 months, however, there was no significant difference between using local anesthesia alone versus local anesthesia combined with steroids in enhancing the function of the affected limb ( 27 ). In 2024, an Evidence-based review show that multiple randomized controlled trials and high-quality observational studies provide varying degrees of evidence supporting the efficacy of ESI compared to placebo in reducing pain and improving function ( 18 ).…”

“…There are three approaches for epidural corticosteroid administration: interlaminar, transforaminal, and caudal. Recent reviews reveal that transforaminal and parasagittal interlaminar ESI providing better outcomes than interlaminar injections (16)(17)(18).…”

5. Sacroiliac joint pain

“…64 See also chapters on lumbosacral radicular syndrome and lumbar facet joint pain. 65,66 Hip pain is usually secondary to arthritis of the joint. Patients usually present with pain in groin area but also frequently have pain in the buttock and lateral hip which can extend below the knee.…”