Central sensitization adversely affects quality of recovery following lumbar decompression surgery

Takahiro Mui; Eiichiro Iwata; Hiroshi Nakajima; Takuya Sada; Masato Tanaka; Akinori Okuda; Sachiko Kawasaki; Hideki Shigematsu; Yasuhito Tanaka

doi:10.1016/j.jos.2022.11.020

Central sensitization adversely affects quality of recovery following lumbar decompression surgery

J Orthop Sci. 2024 Jan;29(1):78-82. doi: 10.1016/j.jos.2022.11.020. Epub 2022 Dec 14.

Authors

Takahiro Mui¹, Eiichiro Iwata², Hiroshi Nakajima¹, Takuya Sada³, Masato Tanaka¹, Akinori Okuda⁴, Sachiko Kawasaki⁵, Hideki Shigematsu⁵, Yasuhito Tanaka⁵

Affiliations

¹ Department of Orthopaedic Surgery, Otemae Hospital, 1-5-34, Otemae, Chuo-ku, Osaka-shi, Osaka, 540-0008, Japan.
² Department of Orthopaedic Surgery, Nara City Hospital, Nara, Japan. Electronic address: iwata@naramed-u.ac.jp.
³ Department of Orthopaedic Surgery, Nara City Hospital, Nara, Japan.
⁴ Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan.
⁵ Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.

PMID: 36526518
DOI: 10.1016/j.jos.2022.11.020

Abstract

Background: Central sensitization (CS) is defined as increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. The CS phenomenon is caused by continuous, intense nociceptor inputs triggering a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in the central nociceptive pathway. Most patients undergoing surgery for lumbar spinal stenosis (LSS) experience symptoms for more than three months; therefore, it is possible that CS is associated with postoperative symptoms of LSS. The aim of this study was to clarify the influence of CS in patients who underwent surgery for LSS.

Methods: We used the Central Sensitization Inventory (CSI) to evaluate CS preoperatively. Clinical and neurological symptoms were assessed before surgery and three months after surgery using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI). To evaluate the correlation between the preoperative CSI score and each parameter of the JOA-BPEQ before and three months after surgery, a Pearson correlation coefficient was used. We also evaluated the correlation between preoperative CSI and improvement scores for each parameter of the JOA-BPEQ for surgery. Similarly, the ODI was assessed.

Results: This study included 118 patients. After surgery, the parameters of lumbar function disorder, social life function disorder, and mental health disorder revealed a statistically significant relationship (r = -0.289, -0.0354, and -0.493, respectively). There was no significant correlation between CSI and improvement scores of the JOA-BPEQ. The ODI assessment after surgery revealed a statistically significant relationship (r = 0.344). There was no significant correlation between the CSI and ODI improvement scores.

Conclusion: This study showed that the severity of the CSI influenced the postoperative outcomes, and that surgical treatment improved the symptoms of LSS regardless of the occurrence of CS preoperatively.

Keywords: Central sensitization; Chronic pain; Decompression surgery; Lumbar spinal stenosis.

MeSH terms

Back Pain
Central Nervous System Sensitization*
Decompression, Surgical
Humans
Lumbar Vertebrae / surgery
Spinal Stenosis* / complications
Treatment Outcome