Pregunta de radiculopatias?

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A 47-year-old man presents with a 1-year history of progressive low back pain that radiates to the right leg and is exacerbated by ambulation. Conservative management measures have failed. Examination reveals decreased pin perception in the right L5-S1 distribution with weak extension of the right great toe and an absent right ankle jerk. Lumbar MRI scan shows a right L5-S1 herniated nucleus pulposus with moderate central canal stenosis and right neural foramen narrowing. Which of the following is the most appropriate next step management?
A. Evaluation for intrathecal analgesic therapy
B. Epidural corticosteroid injection **
C. Epidural lidocaine injection
D. Muscle relaxants and oral analgesics
E. Referral for physical therapy
** = Your answer

Conservative management for low back pain has failed; therefore, invasive treatment options for refractory low back pain such as epidural injection or surgical intervention are indicated. Epidural injection of glucocorticoids plus lidocaine offers minimal or no short-term benefit compared with epidural injection of lidocaine alone.
A double-blind multicenter trial randomized 400 patients with lumbar central spinal stenosis and moderate to severe leg pain and disability to receive epidural injections of glucocorticoids plus lidocaine or lidocaine alone. At 6 weeks, there were no significant differences in physical disability and the intensity of leg pain between groups. A prespecified secondary subgroup analysis with stratification according to type of injection (interlaminar vs. transforaminal) also showed no significant differences at 6 weeks.
* Friedly JL, Comstock BA, Turner JA, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014 Jul 3;371(1):11-21.

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