Differences in Th17 immune activation are seen among radiculopathy and neuropathic pain patients. These cellular and molecular profiles may be translated into biomarkers to improve patient selection for structural spine surgery.

OBJECT Failed-back surgery syndrome has been historically used to describe extremity neuropathic pain in lumbar disease despite structurally corrective spinal surgery. It is unclear whether specific preoperative pain characteristics can help determine which patients may be susceptible to such postoperative disabling symptoms. METHODS This prospective study analyzed surgical microdiscectomy patients treated for lumbar, degenerative, painful radiculopathy. Clinical parameters included general demographics, preoperative and postoperative clinical examination status, self-reported pain and disability scores, and neuropathic pain scores. The screening tests for neuropathic pain were the Douleur Neuropathique 4 and Leeds Assessment of Neuropathic Symptoms and Signs, with correlation tested for ordinal score and screen positivity. Multiple logistic regression analysis was used to define predictors of postoperative symptomatology. RESULTS Twelve percent of the 250 patients with radiculopathy who underwent microdiscectomy experienced persistent postoperative neuropathic pain (PPNP) with only modest, if any, relief of leg pain. The condition was highly associated with abnormal preoperative screen results for neuropathic pain, but not sex, smoking status, or preoperative pain severity (α = 0.05). Good correlation was seen between the 2 screening tests used in this study for both absolute ordinal score (Spearman ρ = 0.84; p < 0.001) and the threshold for terming the patient as having neuropathic pain features (Spearman ρ = 0.48; p < 0.001). Younger age at treatment also correlated with a higher likelihood of developing PPNP (p = 0.03). CONCLUSIONS This population exhibited a low overall frequency of PPNP. Higher neuropathic pain screening scores correlated strongly with likelihood of significant postoperative leg pain. Further work is required to develop more accurate prognostication tools for radiculopathy patients undergoing structural spinal surgery.

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(MSc, PhD, or ≥ 2 years of non-degree research) and full employment was determined by Fisher's exact test. Results: 60% and 26% of graduates currently have full-time staff positions in Canada and the US, respectively. "Underemployment," defined as failure to secure a full-time position in neurosurgery despite a desire to do so (including locums, additional fellowship positions, unemployment and career changes) is currently seen in 12% of graduates, with 20% having been underemployed at some point within 5 years of graduation. Pursuit of research during residency was significantly associated with obtaining full employment (94% vs. 73%, p=0.011). Conclusions: Underemployment is a significant issue in recent neurosurgical graduates from Canadian training programs. Research training during residency appears strongly associated with obtaining full employment.