Treatment of Postlaminectomy Syndrome with Predominantly Radicular Neuropathic Pain in the Lower Limbs
In postlaminectomy syndrome, pain character and distribution are central to treatment selection. When the presentation is predominantly radicular neuropathic pain in the lower limbs — rather than axial nociceptive pain — a distinct, targeted clinical pathway applies.
Clinical scenario
Predominantly radicular neuropathic pain in the lower limbs, with absence of predominantly axial nociceptive pain. Distinguishing radicular from axial pain is a key step in determining which procedures may be efficacious for these patients.
Treatment approach
The protocol involves a targeted, fluoroscopically guided epidural procedure. Whether and when to repeat the intervention depends on the patient's initial response — multiple approaches to access are available.
Route selection, response criteria, and the complete structured regimen are in the full protocol →
Goal: radicular leg pain reduction
References
DOI: 10.4103/jcvjs.jcvjs_118_22
- When deciding on which procedures may be efficacious in FBSS patients, it is useful to determine if the pain is predominantly axial or radicular.
- For those patients with predominantly radicular pain, epidural injection of steroids under fluoroscopic guidance may be achieved through several routes.
- If there is a positive response, repeated injections may occur at an appropriate time interval.
- Many studies have shown the effectiveness of epidural steroids in FBSS.
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