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Lumbar radiculopathy without red flags — MCCQE Part 1 MCQ

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HardBack PainLumbar radiculopathy without red flagsMCCQE Part 1

A 39-year-old has 1 week of radicular low-back pain after lifting. Strength, reflexes, bladder function and perineal sensation are normal; there is no fever, trauma or cancer history. What is the best initial plan?

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Correct answer: B — Remain active, use conservative analgesia and safety-net red flags

In acute radicular low-back pain without red flags or progressive neurologic deficit, initial care is conservative: maintain tolerable activity, use appropriate short-term analgesia and provide explicit return precautions for weakness, bladder dysfunction, saddle sensory change, fever or systemic illness. Routine early imaging does not improve outcomes and often identifies incidental abnormalities. MRI becomes appropriate when serious pathology is suspected or when disabling symptoms persist after at least six weeks and imaging would guide an evidence-based intervention.

Reference: Choosing Wisely Canada, Radiology Recommendations, https://choosingwiselycanada.org/recommendation/radiology/