Neuropathic pain appears to be the main symptom associated with higher disease burden and lower pain alleviation in degenerative lumbar disease fusion patients

INTRODUCTION: The role of neuropathic pain (NP) in persisting pain after degenerative lumbar disease (DLD) fusion surgery appears to be underrecognized and undertreated.

RESEARCH QUESTION: This study assessed NP in DLD patients before and after lumbar interbody fusion (LIF) surgery, and the NP-related burden of disease up to 12-months post-op.

MATERIALS AND METHODS: Within a prospective, multi-center, data-monitored study, a sub-cohort of 146 DLD patients underwent LIF. NP was assessed pre-op and 3-months post-op with a validated Douleur Neuropathique-4 questionnaire. Outcomes were analyzed based on NP occurrence at baseline and post-op. Medication use, back-pain, leg-pain, Oswestry Disability Index (ODI), and quality of life (QoL) were determined pre-op, 3-months and 12-months post-op. Fusion success was evaluated via x-ray and/or CT-scan. Changes were analyzed using paired t-tests and ANCOVA to test for group differences.

RESULTS: NP was present pre-op in 51% of the DLD patients associated with higher back- and leg-pain, and lower QoL. LIF resulted in significant pain relief and improved QoL for all patients. Patients presenting NP post-op had significantly lower back- and leg-pain relief, ODI and QoL up to 1-year post-op. Opioid consumption was higher in the NP group, whereas DM and PVD occurrence, and fusion rates were similar.

DISCUSSION AND CONCLUSION: NP occurred frequently in DLD patients, both before and after spine fusion surgery. Patients with post-operative NP reveal a significant association between NP, lower pain alleviation and higher disease burden up to 12-months post-op, despite higher opioid consumption. NP occurred independently of DM, PVD and fusion success.