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

## TL;DR

Neuropathic pain is common in spine surgery patients and linked to worse outcomes despite higher opioid use.

## Contribution

Identifies neuropathic pain as a key factor in poor post-surgery outcomes in degenerative lumbar disease patients.

## Key findings

- Neuropathic pain before surgery predicts less pain relief and lower quality of life after fusion.
- Post-operative neuropathic pain is associated with worse outcomes despite higher opioid consumption.
- Neuropathic pain occurs independently of diabetes, peripheral vascular disease, and fusion success.

## Abstract

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

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.

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.

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.

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.

•Neuropathic pain in degenerative spine patients is underrecognized and undertreated.•Determining neuropathic pain at pre-op AND post-op are both important.•Pre-op neuropathic pain can be a predictor of persisting post-operative pain.•Post-op neuropathic pain relates to lesser outcomes after spine fusion surgery.

Neuropathic pain in degenerative spine patients is underrecognized and undertreated.

Determining neuropathic pain at pre-op AND post-op are both important.

Pre-op neuropathic pain can be a predictor of persisting post-operative pain.

Post-op neuropathic pain relates to lesser outcomes after spine fusion surgery.