Thread by @adamdobson123

v2.0 with adjustments
Radicular pain and/or radiculopathy. A thread on decision making.

1⃣ Setting the scene

3Ps/serious pathology (red lines) aside. What does the evidence tells us?

✳️Wait & see
✳️Physiotherapy interventions
✳️Nerve root block
✳️Microdiscectomy
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2⃣ A stepped care approach

So, who will get better anyway? What about relieving suffering? We only have early work into trajectories and prognostics.

Current guidelines and national pathways recommend a stepped approach. One that is 'least intrusive'.
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3⃣ Management variables

What characteristics should we consider? To map onto the stepped care approach.

✳️Confidence in dx
✳️Prognostics
✳️Additional factors

4⃣ Confidence in dx

Does the story fit?
Is symptomology consistent?

Does the pt have clear muscle power loss? Any objective numbness with clear borders?
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5⃣ Prognostics

Green: Positive prognostically
Red: Negative prognostically

Use these to plan care and have sensible conversations with pts.
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6⃣Additional variables

Does your pt even want to consider interventional procedures ? Do they understand their options.

Gone are the days that pt MUST have interventions done to them.

What about surgical fitness?
#SharedDecisionMaking
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7⃣
So remember, a stepped approach with least level of intrusiveness. Remember your redlines.

For further CPD come attend our annual @NatSpineNetwork event
mailchi.mp/boa/nsn-17-apr…

Also check out our NHS booklets
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@AnninaBSchmid @SiobhanStynes