Reviewer’s comment concerning “Is NICE guidance for identifying lumbar nerve root compression misguided?” (doi:10.1007/s00586-014-3233-y by T. Germon et al.)

This study is pertinent from the current ongoing consultation from the National Institute of Health and Care Excellence (NICE) with regards update on the low back pain guidance. As per the 2009 guidance, radiculopathy or nerve pain as stated is “People with radiculopathy and/or nerve root pain (unilateral leg pain worse than the back pain, pain radiating to the foot or toes, numbness and paraesthesia in same distribution, which is associated with motor neurological deficit)”.

But there isn’t an agreed definition of radiculopathy and it is more of a clinical diagnosis based on presentation, assessment and imaging. This study found that all the 123 patients had back and leg pain. More than 2/3rd had leg pain more than back pain and nearly 60 % had unilateral leg pain. But only one patient had all the symptoms to fit the 2009 guidance definition as above.

From this study, the authors raise an important point with regards radiculopathy and nerve pain and the difficulty in defining this clinical condition in one statement.