Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
Faculty of Health Sciences, Hokkaido University, North-12, West-5, Kitaku, Sapporo, 060-0812, Japan.
J Orthop Surg Res. 2023 Nov 21;18(1):886. doi: 10.1186/s13018-023-04376-2.
Controversy remains regarding predictors of surgical outcomes for patients with lumbar spinal stenosis (LSS). Pain sensitization may be an underlying mechanism contributing to LSS surgical outcomes. Further, obesity is associated with dissatisfaction and poorer outcomes after surgery for LSS. Therefore, this study aimed to examine the relationship between central sensitization (CS), visceral fat, and surgical outcomes in LSS.
Patients with LSS were categorized based on their central sensitization inventory (CSI) scores into low- (CSI < 40) and high- (CSI ≥ 40) CSI subgroups. The participants completed clinical outcome assessments preoperatively and 12 months postoperatively.
Overall, 60 patients were enrolled in the study (28 men, 32 women; mean age: 62.1 ± 2.8 years). The high-CSI group had significantly higher mean low back pain (LBP), leg pain, and leg numbness visual analogue scale (VAS) scores than the low-CSI group (p < 0.01). The high-CSI group had a significantly higher mean visceral fat area than the low-CSI group (p < 0.01). Postoperatively, LBP VAS score was significantly worse in the high-CSI group. Relative to preoperatively, postoperative leg pain and leg numbness improved significantly in both groups.
We believe that neuro decompression can be effective for LSS surgical outcomes in patients with CS; nonetheless, it should be approached with caution owing to the potential for worsening LBP. Additionally, visceral fat is an important indicator suggesting the involvement of CS.
对于腰椎管狭窄症（LSS）患者的手术结果，仍存在争议。疼痛敏感可能是导致 LSS 手术结果的潜在机制。此外，肥胖与 LSS 手术后的不满意和较差结果有关。因此，本研究旨在探讨 LSS 患者的中枢敏化（CS）、内脏脂肪与手术结果之间的关系。
根据患者的中枢敏化量表（CSI）评分，将 LSS 患者分为低 CSI（CSI<40）和高 CSI（CSI≥40）亚组。参与者在术前和术后 12 个月完成临床结果评估。
总体而言，共有 60 名患者入组（28 名男性，32 名女性；平均年龄：62.1±2.8 岁）。高 CSI 组的平均腰痛（LBP）、腿痛和腿麻木视觉模拟量表（VAS）评分明显高于低 CSI 组（p<0.01）。高 CSI 组的内脏脂肪面积明显高于低 CSI 组（p<0.01）。术后，高 CSI 组的 LBP VAS 评分明显更差。与术前相比，两组术后腿痛和腿麻木均明显改善。
我们认为神经减压术对 CS 患者的 LSS 手术结果可能有效；然而，由于可能导致 LBP 恶化，应谨慎采用。此外，内脏脂肪是提示 CS 参与的重要指标。
