Abstract
The management of patients with lumbosacral radicular pain (LRP) is of primary importance to healthcare professionals. This study aimed to: identify international clinical practice guidelines on LRP, assess their methodological quality, and summarize their diagnostic and therapeutic recommendations. A systematic search was performed (August 2019) in MEDLINE, PEDro, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence (NICE), New Zealand Guidelines Group (NZGG), International Guideline Library, Guideline central, and Google Scholar. Guidelines presenting recommendations on diagnosis and/or treatment of adult patients with LRP were included. Two independent reviewers selected eligible guidelines, evaluated quality with Appraisal of Guidelines Research & Evaluation (AGREE) II, and extracted recommendations. Recommendations were classified into ‘should do’, ‘could do’, ‘do not do’, or ‘uncertain’; their consistency was labelled as ‘consistent’, ‘common’, or ‘inconsistent’. Twenty-three guidelines of varying quality (AGREE II overall assessment ranging from 17% to 92%) were included. Consistent recommendations regarding diagnosis are (‘should do’): Straight leg raise (SLR) test, crossed SLR test, mapping pain distribution, gait assessment, congruence of signs and symptoms. Routine use of imaging is consistently not recommended. The following therapeutic options are consistently recommended (‘should do’): educational care, physical activity, discectomy under specific circumstances (e.g., failure of conservative treatment). Referral to a specialist is recommended when conservative therapy fails or when steppage gait is present. These recommendations provide a clear overview of the management options in patients with LRP.
Highlights
Low back pain (LBP) is globally a major medical problem and a major economic problem [1]
A common recommendation for ‘should do’ concerns magnetic resonance imaging (MRI) when history and physical examination findings are consistent with disc herniation, radiculopathy persists after six weeks, if surgery is considered, severe or progressive neurologic signs and symptoms are present or where an epidural glucocorticosteroid injection is being considered [28,29,30,31,37,39,42,43,44,47,48,49,50]
Guidelines recommend Computed Tomography (CT) scan or Magnetic resonance imaging (MRI) under specific circumstances, and do not recommend the routine use of any form of imaging
Summary
Low back pain (LBP) is globally a major medical problem and a major economic problem [1]. Despite intensified research efforts on LBP management, the population burden and disability related to this disorder is increasing [2,3,4]. Low back-related leg pain is either radicular or referred (non-specific) pain. The former is described as radiating pain where a spinal nerve root is involved causing leg pain along the spinal nerve accompanied by numbness and tingling, muscle weakness and loss of reflexes. The latter is described as pain spreading down the legs arising from structures such as disc, joints or ligaments [8]. An accurate assessment of these patients is needed to provide adequate management and treatment at an early stage of presentation
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