Diagnostic and therapeutic injections may be delivered under fluoroscopy to these sites. In general, spinal injection treatments should be accompanied by an active treatment program which involves learning good biomechanics and proper exercise techniques. Finally, there are times when surgical options should be considered. Patients with leg pain secondary to a mechanical impingement of the nerve root may respond dramatically to the surgical decompression. This becomes emergent if the patient has evidence a neurogenic bowel or bladder.
Progressive weakness is also an indication for more acute surgery.
Patients who are recalcitrant to conservative management over eight to twelve weeks are surgical candidates as well. Patients with lower extremity pain which is produced by chemical radiculitis as opposed to a mechanical impingement do not respond very well to surgery. Patients with axial pain secondary to spondylolisthesis may be candidates for surgery if they do not respond to conservative management as well. Finally, there are times when lumbar fusion for discogenic pain may be appropriate. Up to ninety percent of patients with pain secondary to a spinal etiology are able to respond to conservative management.