Yamada Junichi, Akeda Koji, 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
Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Department of Orthopedic Surgery, Iwasaki Hospital, Tsu, Japan.
Global Spine J. 2024 Nov;14(8):2358-2365. doi: 10.1177/21925682231182333. Epub 2023 Jun 9.
Multicenter prospective study.
Patients with central sensitization (CS) are reported to be at high risk of poor outcomes after spinal surgery. However, the influence of CS on surgical outcomes for lumbar disc herniation (LDH) remains unknown. This study aimed to examine the association between preoperative CS and surgical outcomes in LDH patients.
A total of 100 consecutive patients with LDH (mean age 51.2) who underwent lumbar surgery were included in this study. The extent of CS was evaluated using the central sensitization inventory (CSI), a screening tool for CS-related symptoms. The patients completed the following CSI and clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire (JOABPEQ), and Oswestry Disability Index (ODI). The association between preoperative CSI scores, and preoperative and postoperative COAs was analyzed, and the postoperative changes were statistically evaluated.
The preoperative CSI score significantly decreased 12 months postoperatively. Preoperative CSI scores showed a significant correlation with most COAs; however, a significant correlation was only identified in the social function and mental health domains of JOABPEC postoperatively. Higher preoperative CSI showed worse preoperative COAs; however, all COAs significantly improved regardless of CSI severity. There were no significant differences in any COAs among the CSI severity groups 12 months postoperatively.
The results of this study showed that lumbar surgeries significantly improved the COAs regardless of preoperative severity of CS in patients with LDH.
多中心前瞻性研究。
据报道，中枢敏化（CS）患者在脊柱手术后出现不良结局的风险较高。然而，CS对腰椎间盘突出症（LDH）手术结局的影响尚不清楚。本研究旨在探讨LDH患者术前CS与手术结局之间的关联。
本研究共纳入100例连续接受腰椎手术的LDH患者（平均年龄51.2岁）。使用中枢敏化量表（CSI）评估CS的程度，CSI是一种用于筛查CS相关症状的工具。患者在术前和术后12个月完成以下CSI和临床结局评估（COA）：日本骨科协会（JOA）背痛评分、JOA背痛评估问卷（JOABPEQ）和Oswestry功能障碍指数（ODI）。分析术前CSI评分与术前和术后COA之间的关联，并对术后变化进行统计学评估。
术后12个月，术前CSI评分显著降低。术前CSI评分与大多数COA显著相关；然而，术后仅在JOABPEC的社会功能和心理健康领域发现显著相关性。术前CSI越高，术前COA越差；然而，无论CSI严重程度如何，所有COA均显著改善。术后12个月，CSI严重程度组之间的任何COA均无显著差异。
本研究结果表明，对于LDH患者，无论术前CS严重程度如何，腰椎手术均能显著改善COA。
