Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
Department of Orthopedic Surgery, Iwasaki Hospital, Tsu, Japan.
Eur Spine J. 2023 Dec;32(12):4200-4209. doi: 10.1007/s00586-023-07687-4. Epub 2023 Apr 3.
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.
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.
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.
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.
中枢敏化（CS）对腰椎管狭窄症（LSS）患者的神经症状和手术结果的影响尚不清楚。本研究旨在探讨术前 CS 对 LSS 患者手术结果的影响。
本研究共纳入 197 例连续接受后路减压手术（伴或不伴融合）的 LSS 患者（平均年龄 69.3 岁）。所有患者术前和术后 12 个月完成 CS 量表（CSI）评分和以下临床结局评估（COA）：日本骨科协会（JOA）腰痛评分、JOA 腰痛评估问卷和 Oswestry 残疾指数（ODI）。分析术前 CSI 评分与术前和术后 COA 的相关性，并对术后变化进行统计学评价。
术后 12 个月时，术前 CSI 评分显著降低，且与术前和术后所有 COA 均显著相关。较高的术前 CSI 评分提示术后 COA 较差，JOA 评分、神经症状 VAS 评分和 ODI 的术后改善率较低。多元回归分析表明，术前 CSI 与术后 12 个月的下腰痛（LBP）、心理健康、生活质量（QOL）和神经症状显著相关。
CSI 评估的术前 CS 对手术结果有明显更差的影响，包括神经症状、残疾和 QOL，尤其是与 LBP 和心理因素相关。CSI 可作为一种临床患者报告的指标，用于预测 LSS 患者的术后结局。
