Case Report: Acute on Chronic Lumbar Radiculopathy with Drs. Karvelas and Joves

Рет қаралды 2,371

3 жыл бұрын

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves wrap up the series on lumbar radiculopathy with a case presentation.
This is a case of a young man who presented with a severe acute on chronic lumbar radiculopathy after the holidays. As he was already managed by our office, he presented very acutely (about 1-2 weeks into his flare).
Important concepts that are emphasized with this case are: natural history of lumbar radiculopathy, electrodiagnostic evaluation for lumbar radiculopathy, and a stepwise approach to diagnostic workup and management of a debilitating case of lumbar radiculopathy.
Listen in as the docs walk us through this case and their management choices. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.
References: 1. McCormick Z, Cushman D, Caldwell M, Marshall B, Ghannad L, Eng C, Patel J, Makovitch S, Chu SK, Babu AN, Walega DR, Marciniak C, Press J, Kennedy DJ, Plastaras C. Does Electrodiagnostic Confirmation of Radiculopathy Predict Pain Reduction after Transforaminal Epidural Steroid Injection? A Multicenter Study. J Nat Sci. 2015 Aug;1(8):e140.

Пікірлер: 5

@tandajohnson8617 4 ай бұрын

Very informative. Thank you.

@SpineNerve 4 ай бұрын

Glad it was helpful!

@PanhandlePrepping 3 жыл бұрын

For what reasons do patients stop responding to ESIs? I cannot find anything in my scientific literature searches (of course my access is limited, as I’m not a doctor). Last summer I had a debilitating flare up and my MRI showed several bulging discs, spinal stenosis, and disc as well as joint degeneration. So I received an L4/L5 ESI. Within 48hrs I was nearly pain free, with no sciatica symptoms and only mild to moderate dull aching in my lumbar area (likely arthritic pain). It gave me nearly 5 months of relief. Over the course of 4 years prior to that, I had a few Facet Injections, an ESI in L4/L5 and L5/S1, as well as a bilateral Sacroiliac Injection, a knee injection, and an injection in each heel for plantar fasciitis - all of them gave me significant relief. In fact, the plantar fasciitis has never returned. However, I’m currently having the worst, most debilitating flare up of sciatica symptoms that I’ve ever experienced, which has been ongoing for 8 weeks and is getting progressively worse. My functionality and quality of life is close to non-existent. The pain extends from my low back, through my left buttock, left hamstring, back and outside of calf, outer ankle, and top of foot on pinky toe side - it is out of control. (Conservative home care is having no positive effects - back brace, heat, ice, TENS unit, leg wedge pillow, Voltaren gel, NSAIDs.) Since the most recent flare up began, I’ve received two L4/L5 ESIs, and a bilateral Sacroiliac Injection. None of them provided any relief whatsoever. None - not even 10%. I am scheduled for a L5/S1 injection five days from now. I was told that I cannot receive any more after that as there is a limit on the number of ESIs per year. I was referred to a neurosurgeon 2 weeks ago, but still have not received a call. No prior surgeries or EMG studies. So why would I suddenly stop responding to ESIs? And is it indicative of a more significant problem? I’m feeling pretty hopeless.