Peripheral neuropathy and radicular leg pain emerging in patients recovering from COVID-19 infection

Aim: COVID-19, first recognized in late 2019, has a broad neurological footprint. Beyond diffuse myalgia, some patients report focal pain. This study aimed to describe an atypical clinical presentation of unilateral radicular leg pain mimicking lumbar discopathy after COVID-19 recovery. Material and Methods: We retrospectively reviewed neurosurgery outpatient records (2019–2022) for patients ≥16 years with PCR-confirmed COVID-19 who developed new unilateral lower-limb radicular pain 3–7 days after completion of COVID-19 treatment. Exclusion criteria were prior radicular pain, intervertebral disc disease, spinal stenosis, spondylolisthesis, spinal tumor/trauma, prior interventions, and any structural explanation on imaging. Results: Thirteen patients (mean age 51.3 ± 8.4 years) were included. Acute-phase diffuse myalgia resolved within ~1 week, but unilateral radicular pain persisted after recovery. Neurological examination showed preserved strength and reflexes; anterior-thigh hypoesthesia occurred in 5 patients. Median/peroneal/tibial motor studies were normal and prolonged superficial peroneal sensory latency in 5 patients. Lumbar MRI showed no disc herniation, stenosis, or facet pathology. Median VAS decreased from 7 at presentation to 2 at 6 months (p = 0.003) under conservative therapy (gabapentin + NSAID). Baseline and follow-up laboratory parameters remained within reference ranges. Conclusion: In patients with new unilateral sciatica-like pain after COVID-19 and negative lumbar MRI, clinicians should consider a non-compressive, post-infectious radicular phenotype.