MRI provides excellent images of spinal lesions, replacing myelography in many situations. CSF cytology, protein, glucose, and culture differentiate neoplastic from other chronic meningitides. Electromyography and evoked potentials can help localize the level and determine the severity of root lesions. After repetitive stimulation of the median, peroneal, or posterior tibial nerve, evoked potentials may be delayed at the level of root entry. Treatment Muscle relaxants, analgesics, transdermal electrical nerve stimulation, or topical modalities may provide symptomatic relief.
Specific therapy depends on the etiology of the radiculopathy.
If symptoms and signs continue to progress rapidly, surgical decompression may be required. If cord compression due to bony deformity is present, surgery is usually required. Intrathecal methotrexate may be used to try to slow tumor progression in patients with diffuse meningeal seeding. Epidural and subdural abscesses require immediate surgical drainage and antibiotics for 6 to 8 wk. Symptoms due to diabetes mellitus are managed with better glucose control.