Low back pain aggravation after decompressive surgery for lumbar disc herniation:incidence and risk factors
Objective To investigate the incidence of exacerbated lower back pain after open surgery for lumbar disc herniation and analyze the associated risk factors. Methods A retrospective analysis was conducted on the clinical and imaging data of 227 patients with lumbar disc herniation who underwent open surgery between January 2010 and December 2022. Based on the changes in the numerical rating scale (NRS) for lower back pain during the one-year follow-up after surgery compared to preoperative scores,patients were divided into two groups:pain exacerbation group (score increase of more than 5 points) and pain relief group (score decrease of more than 5 points). General information (age,gender,body mass index,preoperative low back pain,comorbidities,smoking,alcohol consumption),surgical data (surgical method,surgical segment,degree of fusion,surgical time,blood loss,incision size),and imaging data (lumbar lordosis angle,lumbar lordosis correction,Modic changes,and paraspinal muscle degeneration) were compared between two groups of patients. Results There were 31 cases in pain exacerbation group and 196 cases in pain relief group. The incidence of worsening lower back pain was 13.6％. The preoperative lower back pain NRS score,the proportion of L5-S1 surgical segments,the incidence of paravertebral muscle fat infiltration rate (FIR),and the incidence of Modic changes were higher in pain exacerbation group than those in pain relief group (P<0.05). Binary logistic regression analysis showed that preoperative lower back pain NRS,L5-S1 segment surgery,and paraspinal muscle FIR were associated with postoperative exacerbation of lower back pain. Further ROC curve analysis indicated that an NRS score>56 posed a greater risk of postoperative exacerbated lower back pain (AUC=0.913,sensitivity=0.839,specificity=0.923). The risk was also higher for paraspinal muscle FIR>40％ (AUC=0.890,sensitivity=0.746,specificity=0.944). Conclusions The incidence of worsening lower back pain one year after open surgery for lumbar disc herniation is 13.6％. Preoperative lower back pain NRS,L5-S1 segment surgery,and paraspinal muscle FIR are risk factors for worsening lower back pain after open surgery for lumbar disc herniation.
low back painposterior lumbar surgerylumbar disc herniation
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