Prolotherapy and non-surgical treatment of lumbar radiculopathy

non-surgical treatment of lumbar radiculopathy

Ross Hauser, MD
In this article, Ross Hauser, MD discusses Prolotherapy as a non-surgical treatment of lumbar radiculopathy.

The best conventional medicine has to offer for lumbar disc herniation and associated lumbar radiculopathy are surgeries that do not work that well.

Let’s look at research from August 2017 appearing in the British journal of neurosurgery:

“Though different techniques have been successfully employed in the treatment of recurrent lumbar disc herniation, the one which should be considered most ideal has remained a controversy, (minimally invasive surgical techniques).”

“In view of the currently available data and evidence, minimally invasive techniques for revision of recurrent disc herniation do not really appear to be superior to the conventional open surgical approaches and vice-versa. Spinal fusion should not be undertaken in all recurrences but should only be considered as an option for revision when spinal instability, spinal deformity or associated radiculopathy is present.”(1)

Unfortunately, treatments with less than great results in the medical literature are given until “all has failed,” and the patient is sent to surgery. Please see this supporting article on our website: failed back surgery risk factors.

Lumbar Radiculopathy can be confusing. In recent research doctors call some cases “so-called Lumbar Radiculopathy” because it is not radiculopathy

In our experience, many individuals who are diagnosed with lumbar radiculopathy, are more likely to have a “pseudo” radiculopathy. This is a condition where radicular pain comes and goes with changes in activity or changes in position, pinching the nerve intermittently.

If this is the case, then we can look for an underlying spinal instability caused by ligament injury to the lumbar spine which is often overlooked in pre-surgical consults. If ligament injury is there, we can offer the patient Prolotherapy as a non-surgical means to repair the damage, strengthen the spine, alleviate the pain and symptoms of lumbar radiculopathy.

Doctors writing in the Swiss Medical Review (Revue médicale suisse) highlight:

A lumbar disc herniation is a condition frequently encountered in primary care medicine. It may lead to a “compressed nerve,” leading to a nerve root irritation,“a so-called radiculopathy”, with or without a sensorimotor deficit (varying levels of loss of sensory or motor skills).

The majority of lumbar disc herniations can be conservatively treated with physical therapy, analgesics (pain killers), anti-inflammatory therapy or corticosteroids, which may be eventually administered by infiltrations (various injection or infusion techniques).

If a clinico-radiological (MRI and other scans) correlation is present and moderate neurological deficit appears suddenly, if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during four to six months, surgery is then recommended.(2)

What is described above is the typical road to surgery.

Pseudo-Radiculopathy or confirmed-radiculopathy

The longer you wait, the worse your situation becomes

This was a warning issued by doctors writing in the medical journal Clinical spine surgery. Here the doctors noted that the success rates of surgical interventions for lumbar disorders vary significantly depending on multiple factors and, among them, the duration of symptoms.

What these doctors from Boulder Neurosurgical Associates were looking for was to see if there was a “cutoff” time when lumbar decompression and fusion surgery becomes less effective in the conditions with chronic nerve root compression symptomatology. Thus they analyze whether duration of symptoms has any effect on clinical outcomes and primarily resolution of radicular pain symptoms due to degenerative disk disease and stenosis with spondylolisthesis in patients undergoing transforaminal lumbar interbody fusion (TLIF).

The results they achieved showed that the duration of symptoms was a significant predictor of better leg pain resolution, but not back pain resolution, or improvement in disability.

The patients with shorter duration of symptoms had significantly better radicular symptom resolution compared with patients who waited at least 24 months or longer to undergo fusion.(3)

Researchers at Penn State University writing in the medical journal Clinical spine surgery found:

Doctors writing in the Journal of back and musculoskeletal rehabilitationnote that even one epidural steroid injection can be effective in the short term, suggesting radiculopathy can be a transient condition that can be treated without surgery.(5)

Back to the Penn State research, the doctors also found that patients with pain with lumbar extension (most commonly a popular exercise where patients “stretch” their spine by bending backwards) was negatively and significantly related to length of relief duration from the caudal epidural steroid injections.

Epidural steroid injection

It is interesting that patients who failed to have their symptoms managed with epidural injections are treated with epidural injections before and after failed surgery for radiculopathy, only with stronger and more frequent doses.

Epidural steroid injections ease pain temporarily by reducing the size of stressed nerve roots. However concerns over short-term gain long-term costs in the use of epidural steroid injection side-effects have been noted.

Epidurals are part of the common treatments for light cases of lumbar radiculopathy which usually include NSAIDs (non-steroidal anti-inflammatory drugs), physical therapy, or chiropractic treatment. Although many patients respond very well to these treatments, they are only temporary fixes that can help ease the pain and only relieve some symptoms of the condition.

Further, research in the Journal of the American Medical Association, JAMA said that oral steroids as compared to placebo, offered minor improvement in function but did not improve pain conditions.(6)

Diagnosis and Treatment of Lumbar Radiculopathy

Many patients will be sent off for physical therapy. These patients often see mixed results.

Physical Therapy:


In utilizing Prolotherapy as a treatment, diagnosing lumbar radiculopathy as a transient pain, as mentioned above, requires a physical examination, manipulation, and palpitation of the suspect area.

Most often individuals, as we discussed, who are diagnosed with lumbar radiculopathy, really have more of a radicular pain that comes and goes with changes in activity or changes in position.

This means the nerve gets pinched intermittently possibly caused by an underlying ligament injury to the lumbar spine. The ligaments become weaker and allow for more movement than normal. The vertebrae then move excessively, and the nerve can get pinched. This pinching causes extreme pain down the legs and feet. If the lumbar radiculopathy is intermittent, then the leg pain will be occasional or intermittent. Prolotherapy to the injured and weakened areas will stabilize the lumbar vertebrae. Intermittent radiculopathy generally responds very well to Prolotherapy.

How does Prolotherapy help radiculopathy?

Lower Back Prolotherapy


Radiculopathy by definition means a nerve is being compromised leading to symptoms in the extremity. We find that 90% of people coming in with the diagnosis of radiculopathy do not have a pinched nerve.

The majority has referred pain down the extremity (leg or arm) from a ligament injury in their pelvis, lower back, neck, or upper back. Three to six Prolotherapy sessions and the majority of these pains subside. For the other 10 percent that have a true radiculopathy the following is typically present:

In the case of a true pinched nerve, most Prolotherapists will get the person some pain control while the Prolotherapy is working. The person with a true radiculopathy needs to decrease the inflammation of the disc material pressing on the nerve while the Prolotherapy helps stabilize the herniated areas.

Obviously, the person gets Prolotherapy to the areas.

Up to four Prolotherapy sessions are sometimes needed. The above approach has been used at Caring Medical Rehabilitation Services for years. It has kept a lot of people out of surgery.

In our experience the above approach even with herniated discs is around 90% successful. Of course, we have our handful of cases that have needed surgical consultation and surgery. We are grateful the surgeons are there for back-up. Even for an acute herniated disc the surgeon is second line therapy, or the person with a pseudo- or true radiculopathy the treatment of choice is Prolotherapy.

Our research: Published research from Caring Medical and Rehabilitation Services

In Caring Medical and Rehabilitation Services published research in the Journal of Prolotherapy we cited our own data and that of others in demonstrating the effectiveness of Prolotherapy for back pain.

In our research we reported on 145 patients who experienced low back pain an average of 58 months, who were treated on average with four sessions of dextrose (12.5%) Prolotherapy, quarterly, at a charity clinic.

The patients were contacted on average 12 months after their last Prolotherapy session.In these patients:

Results were similar in the patients who were told by at least one medical doctor that there was no other treatment option (55 patients) or that surgery was the only option (26 patients).6

If you have a question about Prolotherapy as a non-surgical treatment of lumbar radiculopathy, you can get help and information from our Caring Medical staff

1 Onyia CU, Menon SK. The debate on most ideal technique for managing recurrent lumbar disc herniation: a short review. British Journal of Neurosurgery. 2017 Aug 22:1-8. [Google Scholar]

2. Corniola MV, Tessitore E, Schaller K, Gautschi OP. Lumbar disc herniation–diagnosis and treatment. Rev Med Suisse. 2014 Dec 10;10(454):2376-82.  [Google Scholar]

3 Villavicencio AT, Nelson EL, Rajpal S, Burneikiene S. The Timing of Surgery and Symptom Resolution in Patients Undergoing Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disk Disease and Radiculopathy. Clinical spine surgery. 2016 May. [Google Scholar]

4 Billy GG, Lin J, Gao M, Chow MX. Predictive Factors of the Effectiveness of Caudal Epidural Steroid Injections in Managing Patients With Chronic Low Back Pain and Radiculopathy. Clinical spine surgery. 2017 Jul 1;30(6):E833-8. [Google Scholar]

5 Taskaynatan MA, Tezel K, Yavuz F. The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain due to lumbar disc herniation two years after treatment. J Back Musculoskelet Rehabil. 2014 Oct 15. [Google Scholar]

6 Goldberg H, Firtch W, Tyburski M, Pressman A, Ackerson L, Hamilton L, Smith W, Carver R, Maratukulam A, Won LA, Carragee E, Avins AL. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015 May 19;313(19):1915-23. doi: 10.1001/jama.2015.4468. [Google Scholar]

7. Hahne AJ, Ford JJ, Hinman RS, Richards MC, Surkitt LD, Chan AY, Slater SL, Taylor NF. Individualized functional restoration as an adjunct to advice for lumbar disc herniation with associated radiculopathy. A pre-planned subgroup analysis of a randomized controlled trial. Spine J. 2016 Oct 17. [Google Scholar]

8.  Hauser RA, Hauser MA. Dextrose Prolotherapy for unresolved low back pain: a retrospective case series study. Journal of Prolotherapy. 2009;1:145-155.

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