TITLE:
Persistent Post-Operative Low Back Pain, True Radiculopathy and Pseudoradiculopathy: Retrospective Observational Study and Point of View of a Practicing Clinician
AUTHORS:
Reynaldo P. Lazaro
KEYWORDS:
Radiculopathy, Complex Regional Pain, Low Back Pain, Sinuvertebral Nerve, Cytokines, Neurotrophins
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.11 No.10,
October
14,
2021
ABSTRACT: 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.