Persistent Post-Operative Low Back Pain, True Radiculopathy and Pseudoradiculopathy: Retrospective Observational Study and Point of View of a Practicing Clinician

Purpose: Persistent Postoperative Low Back Pain (PLBP) is inordinately common, and has been attributed to various pre-operative and post-operative anatomical and mechanical factors in the spine. It may or may not be associated with sensory symptoms in the lower extremities—frequently termed “radiculopathy”—with or without Electromyographic (EMG) or imaging abnormalities. The present study aimed to look at these various symptoms in the lower extremities from a different angle and perspective and to clarify the distinction between true radiculopathy and pseudoradiculopathy; and determine their possible relationship with the outcome of surgery. Methods: Medical records of twenty-four patients with PLBP who were referred to the author for clinical and electrodiagnostic examinations several months after surgery were reviewed. Clinical symptomatology, with special reference to the presence or absence of sensory and motor deficits together with EMG findings, were reviewed and categorized into 4 groups: non radicular, true radiculopathy, pseudoradiculopathy, and peripheral neuropathy. Results: Lower Back Pain (LBP) in all patients persisted following successful and uncomplicated surgery. LBP in patients with true radiculopathy persisted but was less disabling when the neurologic deficits resolved partially or significantly. As expected, the neurologic deficits related to peripheral neuropathy, together with LBP, remained persistent. Conclusion: LBP and various sensory and motor symptoms in the lower extremities are 2 distinct entities, both clinically and pathophysiologically. These sensory and motor symptoms, together with the heightened activity of various pro-inflammatory cytokines and neurotrophins—setting aside the various anatomical and mechanical factors in the spine—can influence the outcome of surgery, favorably or unfavorably.