Background: Although multiple researchers have reported clinical outcomes of lumbar spine surgery, only few focused on postoperative residual pain. In this study, we aimed focused on residual neuropathic pain (NeP) after lumbar spine surgery and elucidated its details and drug treatment status. Method: In this study, we included 257 patients who underwent lumbar spine surgery and followed up for > 3 months (141 men and 116 women, mean age: 67 years). The diagnoses included 149 cases with spinal canal stenosis, 72 with spondylolisthesis, 3 with fracture, 16 with intervertebral disc herniation, 2 with cauda equina tumor, and 3 with adult spinal deformity. An assessment tool for NeP, the PainDetect questionnaire (PDQ), was administered, and a PDQ score ≥13 was defined as NeP. In all cases, we observed all five items of the Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ): pain-related disorders (PD), lumbar spine dysfunction (LSD), gait disturbance (GD), social life dysfunction (SLD), and psychological disorders (PD), along with the Oswestry disability index (ODI) and EuroQol-5 dimensions (EQ5D) for low back pain and health-related quality of life (QOL). In addition to the details of drugs for NeP, its treatment satisfaction was also reviewed. After dividing the patients into the NeP and non-NeP groups, all measurements were compared between two groups. Result: Fifty-three cases (20.6%) were included as the NeP group, and LSD, GD, SLD and PD of JOABPEQ, ODI score, and EQ5D score were significantly poorer in the NeP group than in the non-NeP group. Only 87 patients (35.8%) received medication for pain, with 61.2% and 29.3% in the NeP and non-NeP groups, respectively; a significantly higher rate of medication was observed in the NeP group than in the non-NeP group. In a sub-analysis of the population receiving pain medication, the NeP group showed significantly poorer treatment satisfaction than the non-NeP group. Regarding the details of medication in the NeP group, nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentinoids, tramadol, and serotonin–norepinephrine reuptake inhibitors (SNRI) were used in 13 (43.3%), 6 (20%), 17 (56.6%), 10 (33.3%), and 6 (20%) cases, respectively. Discussion: The prevalence of residual NeP after lumbar spine surgery was high, and residual NeP would negatively impact low back pain and health-related QOL postoperatively. However, only approximately 60% of patients received medication for postoperative residual NeP, which would be insufficient. Gabapentinoids and SNRIs were the first-line drugs according to the Guidelines for the Pharmacologic Management of NeP, Second Edition, from the Japan Society of Pain Clinicians; however, spinal surgeons rarely use SNRIwe should focus more on residual NeP postoperatively, and medication based on the guidelines would be needed. Spine surgery will be the “start” but not the “goal.”