Central sensitization as a predictive factor for the surgical outcome in patients with lumbar spinal stenosis: a multicenter prospective study

• Published in: European spine journal Vol. 32; no. 12; pp. 4200 - 4209
• Main Authors: Akeda, Koji, Yamada, Junichi, Takegami, Norihiko, Fujiwara, Tatsuhiko, Murata, Koichiro, Kono, Toshibumi, Sudo, Takao, Imanishi, Takao, Kurata, Tatsuya, Kawakita, Eiji, Sakakibara, Toshihiko, Kondo, Tetsushi, Takegami, Kenji, Sato, Masayoshi, Sudo, Akihiro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2023; Springer Nature B.V
• Subjects: Aged; Back pain; Central Nervous System Sensitization; Decompression; Decompression, Surgical - adverse effects; Humans; Low back pain; Low Back Pain - complications; Low Back Pain - surgery; Lumbar Vertebrae - surgery; Medicine; Medicine & Public Health; Multiple regression analysis; Neurosurgery; Original Article; Patients; Prospective Studies; Quality of Life; Spinal stenosis; Spinal Stenosis - complications; Spinal Stenosis - diagnosis; Spinal Stenosis - surgery; Surgical Orthopedics; Surgical outcomes; Treatment Outcome; Central sensitization; Lumbar surgery; Prospective studies; Lumbar spinal stenosis; Patient-reported outcome measures
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-023-07687-4

Purpose
The impact of central sensitization (CS) on neurological symptoms and surgical outcomes in patients with lumbar spinal stenosis (LSS) remains unknown. This study aimed to investigate the influence of preoperative CS on the surgical outcomes of patients with LSS.
Methods
A total of 197 consecutive patients with LSS (mean age 69.3) who underwent posterior decompression surgery with or without fusion were included in this study. The participants completed the CS inventory (CSI) scores and the following clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire, and Oswestry Disability Index (ODI). The association between preoperative CSI scores and preoperative and postoperative COAs was analyzed, and postoperative changes were statistically evaluated.
Results
The preoperative CSI score significantly decreased at 12 months postoperatively and was significantly correlated with all COAs preoperatively and 12 months postoperatively. Higher preoperative CSI showed worse postoperative COAs and inferior postoperative improvement rates in the JOA score, VAS score for neurological symptoms, and ODI. Multiple regression analysis demonstrated that preoperative CSI was significantly associated with postoperative low back pain (LBP), mental health, quality of life (QOL), and neurological symptoms at 12 months postoperatively.
Conclusions
Preoperative CS evaluated by CSI had a significantly worse impact on surgical outcomes, including neurological symptoms, disability, and QOL, especially related to LBP and psychological factors. CSI can be used clinically as a patient-reported measure for predicting postoperative outcomes in patients with LSS.