Low back pain.

Area of Science:

• Neurology
• Orthopedics
• Rehabilitation Medicine

Background:

• Lumbosacral (L-S) radicular pain is frequently treated surgically, despite evidence suggesting non-operative management is often more appropriate.
• Patient and physician perception often incorrectly equates pain severity with disc derangement seriousness, overlooking the natural history of remission.

Purpose of the Study:

• To question the high rate of surgical interventions for L-S radicular pain.
• To advocate for a shift towards conservative management and specialized physiatric evaluation for back pain.

Main Methods:

• Review of the natural history of L-S radicular pain and disc herniation.
• Discussion of electrodiagnostic study utility in differentiating reversible and permanent nerve root compromise.
• Comparative analysis of surgical rates between the US and Europe.

Main Results:

• Radicular pain is inversely proportional to associated weakness; sudden pain cessation indicates a "dead" root and significant weakness.
• Electrodiagnostic studies can confirm L-S radiculopathy within weeks and differentiate reversible from permanent weakness.
• The US performs significantly more lumbar laminectomies than Europe, suggesting overuse of surgical treatment.

Conclusions:

• Surgery is not the primary treatment of choice for most L-S radicular pain or associated weakness, whether reversible or permanent.
• Physiatric evaluation and conservative management, including patient education on anatomy and biomechanics, are crucial.
• Second opinions from non-surgical specialists like physiatrists should be standard for major lumbar surgeries to reduce unnecessary procedures.