Discogenic lumbosacral radiculopathy. Recommendations of the Russian Association for the Study of Pain, the Russian Society of Neurologists, the Russian Association of Neurosurgeons, the Interventional Pain Management Association, and the All-Russian Public Organisation for the Promotion of Rehabilitation 'Union of Rehabilitators of Russia'

When examining a patient with lumbosacral pain (lower back pain), it is necessary to rule out any specific underlying causes. The diagnosis of discogenic lumbosacral radiculopathy (DLR) is based on clinical examination; magnetic resonance imaging (MRI) is useful for ruling out other causes of radiculopathy and assessing the characteristics of a herniated intervertebral disc. There is insufficient justification for early MRI (within the first 4 weeks) unless there are signs of cauda equina syndrome, or epidural glucocorticoid injection or urgent surgical treatment is planned. It is recommended that patients with DLR be informed about the possibility of disc herniation regression and recovery, and the advisability of maintaining physical activity. Non-steroidal anti-inflammatory drugs may be used to relieve pain; if these are ineffective, epidural administration of local anaesthetics and glucocorticoids under X-ray or ultrasound guidance may be considered. During the acute phase, it is advisable to perform therapeutic exercises under specialist supervision and to attend educational sessions on movement ergonomics. For subacute and chronic DLR, therapeutic exercises, manual therapy and psychological therapy are recommended. Consultation with a neurosurgeon regarding a possible microdiscectomy is indicated as a matter of urgency in the presence of cauda equina syndrome, as well as if there is no response to conservative treatment within 4–8 weeks. For preventive purposes, the patient is advised to undertake therapeutic exercises and an educational programme on avoiding excessive physical and static loads.

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