Establishing a Common Term and Definition for Non-Structural Postoperative Radicular Pain Following Lumbar Decompression: A Scoping Review

Abstract

Background: Patients often report recurrent or new radicular pain after direct or indirect lumbar decompressions. Such pain may result from structural causes such as implant subsidence or incomplete decompression, but often the pain lacks a clear structural cause. The wide variability in terms used to define non-structural, postoperative radicular pain complicates its analysis. Purpose: We aimed to elucidate the terminology and classification systems used to describe postoperative radicular pain after lumbar decompression and/or fusion surgery without clear structural etiology and to propose a new clinical definition. Methods: We conducted a scoping review that followed the Joanna Briggs Institute scoping review methodology and the Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews guidelines. The search included studies from 2011 to 2023 involving patients over 18 years of age experiencing postoperative radicular pain after lumbar decompression and/or fusion. Results: Our analysis of 20 included articles found the most common terms used for non-structural radicular pain after lumbar decompression and/or fusion surgery were “postoperative radiculitis” (8 studies, 40%) and “failed back surgery syndrome” (FBSS) (5 studies, 25%). “Radiculitis” and related terms typically described short-term, self-limited radicular pain; “FBSS” and similar terms referred to chronic, treatment-resistant back, and leg pain. The incidence of non-structural postoperative radicular pain ranged from 0.9% to 43.8%. Conclusions: This scoping review found inconsistencies in the terms used to describe postoperative radicular pain after lumbar decompression and/or fusion surgery, and we therefore propose defining “postoperative radiculitis” as transient radicular pain, without structural pathology or motor weakness, typically emerging after initial symptom resolution (within 3 months of surgery) and resolving within 6 months of surgery. Future studies should focus on validating diagnostic metrics, exploring risk factors, and identifying prevention strategies and treatments for postoperative radiculitis.