Lumbosacral radicular pain

Lumbosacral radicular pain is a challenging diagnosis, as numerous anatomical abnormalities including disc herniation and lumbar stenosis may be the source with symptoms similar to other low back pain maladies. If imaging is warranted, an MRI is the diagnostic modality of choice, while selective nerve root blocks have been practiced as the gold standard of diagnosis, especially useful in patients with negative findings on radiography but with clinical signs of nerve root irritation. Interventional options such as selective nerve root blocks or transforaminal epidural injections of a mixture of steroid and local anesthetic under fluoroscopic guidance may provide therapeutic benefit. By focusing on the clinical symptoms and utilizing a proper diagnostic and therapeutic algorithm, in this chapter we will explore the approaches a pain clinician may apply and treat this patient population in an effective and safe manner.