International Orthopaedics

, Volume 43, Issue 4, pp 969–973 | Cite as

Persistent radiculopathy after surgical treatment for lumbar disc herniation: causes and treatment options

  • Ashley Rogerson
  • Jessica Aidlen
  • Louis G. JenisEmail author
Original Paper



Lumbar disc surgery is a common procedure in the USA. It is frequently performed with good or excellent results in most patients. This article reviews common causes of persistent radiculopathy after surgical intervention.


We performed an extensive review of the literature as well as applying our own experience.


Common causes of persistent leg pain following operative intervention include re-herniation, epidural fibrosis, biochemical/physiologic changes in the nerve root, and psychosocial issues.


Patients with persistent leg pain after surgical treatment of lumbar disc herniation can pose a challenging clinical problem. Summary of these topics and available treatment options are reviewed.


Chronic radiculopathy Lumbar disc herniation Prevalence 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Deyo RA, Tsui-Wu YJ (1987) Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine 12:264–268CrossRefGoogle Scholar
  2. 2.
    Kelsey JL, White AA (1980) Epidemiology and impact of low back pain. Spine 5:133–142CrossRefGoogle Scholar
  3. 3.
    Weinstein JN et al (2006) Surgical vs nonoperative treatment for lumbar disk herniation. The Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA 22:2441–2450CrossRefGoogle Scholar
  4. 4.
    Atlas SJ et al (1996) The Maine Lumbar Spine Study, part II. 1-year outcomes of surgical and non-surgical management of sciatica. Spine 21:1777–1786CrossRefGoogle Scholar
  5. 5.
    Pheasant HC, Dyck P (1982) Failed lumbar disc surgery: cause, assessment and treatment. Clin Orthop Relat Res 164:93–109Google Scholar
  6. 6.
    Taylor VM, Deyo RA, Cherkin DC, Kreuter W (1994) Low back pain hospitalization: recent United States trends andregional variations. Spine 19:1207–1213CrossRefGoogle Scholar
  7. 7.
    Ito TI et al (2001) Types of lumbar herniated disc and clinical course. Spine 26:648–651CrossRefGoogle Scholar
  8. 8.
    Butterman GR (2004) Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. J Bone Joint Surg 86-A:670–679CrossRefGoogle Scholar
  9. 9.
    Weber H (1983) Lumbar disc herniation: a controlled, prospective study with ten years of observation. Spine 8:131–140CrossRefGoogle Scholar
  10. 10.
    Kayaoglu CR, Calikoglu C, Binler S (2003) Re-operation after lumbar disc surgery: results in 85 cases. J Int Med Res 31:318–323CrossRefGoogle Scholar
  11. 11.
    McGirt MJ et al (2009) Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 64:338–345CrossRefGoogle Scholar
  12. 12.
    Loupasis GA et al (1999) Seven- to 20-year outcome of lumbar discectomy. Spine 24:2312–2317CrossRefGoogle Scholar
  13. 13.
    Suk KS et al (2001) Recurrent lumbar disc herniation: results of operative management. Spine 26:672–676CrossRefGoogle Scholar
  14. 14.
    Cinotti G, Roysam GS, Eisenstein SM et al (1998) Ipsilateral recurrent lumbar disc herniation: a prospective, controlled study. J Bone Joint Surg Br 80:825–832CrossRefGoogle Scholar
  15. 15.
    Cheng J, Wang H, Zheng W et al (2013) Reoperation after lumbar disc surgery in two hundred and seven patients. Int Orthop 37:1511–1517CrossRefGoogle Scholar
  16. 16.
    Li Z et al (2018) Clinical recurrence and risk factors of recurrent lumbar disc herniation. Spine 43:1463–1469CrossRefGoogle Scholar
  17. 17.
    Carragee EJ et al (2003) Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and annular competence. J Bone Joint Surg 85-A:102–108CrossRefGoogle Scholar
  18. 18.
    O’Connell JE (1951) Protrusions of the lumbar intervertebral disc, a clinical review based on five hundred cases treated by excision of the protrusion. J Bone Joint Surg Br 33:8–30CrossRefGoogle Scholar
  19. 19.
    Carragee EJ, Helms E, O’Sullivan GS (1996) Are postoperative activity restrictions necessary after posterior lumbar discectomy? Spine 21:1893–1897CrossRefGoogle Scholar
  20. 20.
    Carragee EJ, Han MY, Yang B, Kim DH, Kraemer H, Billys J (1999) Activity restrictions after posterior lumbar discectomy: a prospective study of outcomes in 152 cases with no postoperative restrictions. 24: 2346–2351Google Scholar
  21. 21.
    Robertson JT (1996) Role of peridural fibrosis in the failed back: a review. Eur Spine J 5:S2–S6CrossRefGoogle Scholar
  22. 22.
    Herrera IH et al (2013) Evaluation of the postoperative lumbar spine. Radiologia 55:12–23CrossRefGoogle Scholar
  23. 23.
    Bundschuh CV et al (1988) Epidural fibrosis and recurrent disk herniation in the lumbar spine: MR imaging assessment. Am J Roentgenol 150:923–932CrossRefGoogle Scholar
  24. 24.
    Kayama S et al (1996) Incision of the annulus fibrosus induces nerve root morphologic, vascular and functional changes. Spine 21:2539–2543CrossRefGoogle Scholar
  25. 25.
    Ross JS et al (1996) Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. Neurosurg 38(4):855–863CrossRefGoogle Scholar
  26. 26.
    Coskun E et al (2000) Relationships between epidural fibrosis, pain, disability and psychological factors after lumbar disc surgery. Eur Spine J 9:218–223CrossRefGoogle Scholar
  27. 27.
    Jonsson BO, Stromqvist B (1993) Repeat decompression of lumbar nerve roots: a prospective 2 year evaluation. J Bone Joint Surg Br 75-B:894–897CrossRefGoogle Scholar
  28. 28.
    Benoist M et al (1980) Postoperative lumbar epiduro-arachnoiditis: diagnostic and therapeutic aspects. Spine 5:432–436CrossRefGoogle Scholar
  29. 29.
    Davis RA (1994) A long-term outcome analysis of 984 surgically treated herniated lumbar discs. J Neurosurg 80:415–421CrossRefGoogle Scholar
  30. 30.
    Lindahl O, Rexed B (1951) Histologic changes in spinal nerve roots of operated cases of sciatica. Acta Orthop Scand 20:215–225CrossRefGoogle Scholar
  31. 31.
    Takahashi N et al (2003) Pathomechanics of nerveroot injury caused by disc herniation: an experimental study of mechanical compression and chemical irritation. Spine 28:435–441Google Scholar
  32. 32.
    Olmarker K, Myery RR (1998) Pathogenesis of sciatic pain: role of herniated nucleus pulposus and deformation of spinal nerve root and dorsal root ganglion. Pain 78:99–105CrossRefGoogle Scholar
  33. 33.
    Olmarker K, Rydevil B, Nordborg C (1993) Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equine nerve roots. Spine 18:1425–1432CrossRefGoogle Scholar
  34. 34.
    Brisby H et al (2000) Nitric oxide as a mediator of nucleus pulposus-induced effects on spinal nerve roots. Orthop Res 18:815–820CrossRefGoogle Scholar
  35. 35.
    Kang JD et al (1996) Herniated lumbar intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine 21:271–277CrossRefGoogle Scholar
  36. 36.
    Miyamoto H et al (2002) The role of cyclooxygenase-2 in lumbar disc herniation. Spine 27:2477–2483CrossRefGoogle Scholar
  37. 37.
    Dolgun H et al (2014) Gabapentin versus pregabalin in relieving early post-surgical neuropathic pain in patients after lumbar disc herniation surgery: a prospective clinical trial. Neurol Res 36:1080–1085CrossRefGoogle Scholar
  38. 38.
    Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L (1998) Gabapentin for the treatment of post herpetic neuralgia: a randomized controlled trial. JAMA 280:1837–1842CrossRefGoogle Scholar
  39. 39.
    Devor M, Wall PD (1990) Cross-excitation in dorsal root ganglia of nerve-injured and intact rats. J Neurophysiol 64:1733–1746CrossRefGoogle Scholar
  40. 40.
    Riew KD et al (2000) The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain: a prospective, randomized, controlled, double-blind study. JBJS 82-A:1589–1593CrossRefGoogle Scholar
  41. 41.
    Vroomen PC et al (2000) Conservative treatment of sciatica: a systematic review. J Spinal Disord 13:463–469CrossRefGoogle Scholar
  42. 42.
    Vad VB et al (2002) Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective, randomized study. Spine 27:11–16CrossRefGoogle Scholar
  43. 43.
    Ng L, Chaudry N, Sell P (2005) The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine 30:857–862CrossRefGoogle Scholar
  44. 44.
    Manchikanti L et al (2010) Evaluation of the effectiveness of lumbar interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind controlled trial. Pain Physician 13:343–355Google Scholar
  45. 45.
    Herron LD, Pheasant HC (1982) Changes in MMPI profiles after low-back surgery. Spine 7:591–597CrossRefGoogle Scholar
  46. 46.
    Wilfing FJ, Klonoff H, Kokan P (1973) Psychological, demographic and orthopaedic factors associated with prediction of outcome of spinal fusion. Clin Orthop 90:153–160Google Scholar
  47. 47.
    Hasenbring H et al (1994) Risk factors of chronicity in lumbar disc patients: a prospective investigation of biologic, psychologic and social predictors of therapy outcome. Spine 19:2759–2765CrossRefGoogle Scholar
  48. 48.
    Atlas SJ et al (2010) The impact of workers’ compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation SPORT. Spine 35:89–97CrossRefGoogle Scholar
  49. 49.
    DeBerard MS et al (2009) Outcomes and presurgery correlates of lumbar discectomy in Utah Workers’ Compensation patients. Spine J 9:193–203CrossRefGoogle Scholar
  50. 50.
    Atlas SJ et al (2000) Long-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation. JBJS 82:4–15CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Ashley Rogerson
    • 1
  • Jessica Aidlen
    • 2
  • Louis G. Jenis
    • 2
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryTufts Medical CenterBostonUSA
  2. 2.Department of Orthopedic Surgery, Division of Spine SurgeryNewton Wellesley HospitalNewtonUSA
  3. 3.Newton Wellesley HospitalNewtonUSA

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