Neuropathic pain syndrome during surgical interventions on the lumbar spine

Abstract

BACKGROUND: The presence of neuropathic pain syndrome (NPS) in patients with degenerative spinal diseases can make determining the tactics of surgical treatment challenging and increases the risk of residual or recurrent pain syndrome after surgery. AIM: To investigate the perioperative course in patients with degenerative diseases of the lumbar spine depending on NPS. MATERIALS AND METHODS: This prospective observational study included patients with planned surgical treatment for degenerative lumbar spinal stenosis. The study design included two visits: preoperative and 3 months after surgery follow-up. NPS assessment (DN4), back and leg pain intensity (NPRS back, NPRS leg), and disability index (ODI) were collected in both visits. RESULTS: Overall, 169 patients were included; 48.5% of patients had NPS initially and 26% had NPS after surgery. NPS remained in 7.3% of patients and developed in 13% without initial signs before surgery. Patients with NPS upon admission had a higher intensity of pain in the back (6.82±2.41 vs. 5.42±2.66; p=0.041) and legs (7.43±2.34 vs. 6.32±2.16; p=0.017) than non-NPS patients. Patients with NPS at 3-month follow-up had higher intensity of pain in the back (4.31±2.52 vs. 2.31±2.38; p=0.012) and legs (4.71±2.91 vs. 1.55±2.27; p=0.003) than non-NPS patients. CONCLUSION: Thus, 48.5% of patients with degenerative lumbar spinal stenosis had NPS before surgical treatment, and in 13% of patients, neuropathy developed after surgery. Patients with NPS, identified before surgical treatment or after surgery, have a higher pain intensity (1.2–1.3 times higher before surgery, 1.9–3 times higher after surgery) and report less pain regression after surgery. The presence of neuropathic pain syndrome at all periods of observation (or its appearance) complicates patient recovery and postoperative observation.