# Multidimensional burden of low back pain: A prospective cross sectional study of patient-reported outcomes and sociodemographic factors at a tertiary neurosurgical center

## TL;DR

Low back pain causes severe physical, mental, and occupational issues, with depression and erectile dysfunction strongly linked to disability.

## Contribution

A prospective study reveals multidimensional impacts of low back pain and identifies key predictors of disability and surgery in neurosurgical patients.

## Key findings

- High pain intensity (NRS 7.0) and severe disability (ODI 57.4) were reported by patients with lumbar spine disorders.
- Depression and older age were significant predictors of greater disability, while surgery was linked to higher baseline disability.
- Occupational disability was high among working-age patients, with 39.4% currently work-disabled.

## Abstract

Low back pain (LBP) significantly impacts patients’ physical function, mental health, erectile dysfunction (ED) in males, and occupational status. However, comprehensive prospective assessments of these interrelated dimensions in specialized neurosurgical outpatient settings remain sparse.

Research Question: This study aimed to prospectively evaluate functional disability, depression, erectile dysfunction (ED), occupational impairment, and their associations with demographic and lifestyle factors among patients presenting to a neurosurgical outpatient clinic.

Between February and June 2025, we prospectively enrolled 247 consecutive patients (mean age 60.4 ± 16.0 years, 53.8 % male) presenting to the neurosurgical outpatient clinic at Heidelberg University Hospital with degenerative lumbar spine disorders, of whom 110 (44.5 %) subsequently underwent decompression surgery. Patients completed validated patient-reported outcome measures (PROMs), including pain intensity (Numeric Rating Scale [NRS]), functional disability (Oswestry Disability Index [ODI]), depression (PHQ-9), and erectile dysfunction (IIEF-5). Correlation analyses and regression models assessed associations among these outcomes and relevant demographic and lifestyle variables.

Patients reported high pain intensity (NRS 7.0 ± 2.2), severe functional disability (ODI 57.4 ± 16.5; 82.2 % severely disabled or worse), frequent moderate-to-severe depressive symptoms (42.2 %), and prevalent erectile dysfunction among males (55 %). Multivariate analyses identified depression severity (PHQ-9; B = 1.30, p < 0.001), older age (B = 0.20, p = 0.045), and surgery (B = 6.13, p = 0.049) as significant predictors of greater disability. Erectile dysfunction severity in males was independently associated with higher disability (B = −0.18, p = 0.002) and older age (B = −0.32, p < 0.001). Undergoing surgery was significantly predicted by higher baseline disability (ODI; OR = 1.04, p = 0.032) and private insurance (OR = 22.39, p < 0.001). Among working-age patients (≤65 years, n = 142), occupational disability was notably high, with 39.4 % currently work-disabled and an additional 15.5 % having experienced disability within the past year.

This prospective study highlights the significant multidimensional burden of low back pain among neurosurgical outpatients, characterized by substantial functional disability, high prevalence of depression, frequent erectile dysfunction, and marked occupational impairment. Our results underscore the critical need for routine psychological screening, proactive sexual health assessment, and targeted occupational rehabilitation within specialized neurosurgical care pathways. Implementing these comprehensive approaches may improve patient outcomes, support return to work, and mitigate potential socioeconomic impacts associated with degenerative lumbar spine disorders.

•Heavy burden in lumbar disease: High pain (NRS 7.0), severe disability (ODI 57), 42% depression, and 55% erectile dysfunction.•Disability was independently predicted by higher PHQ-9 scores and older age in men, greater ED severity related to higher disability and older age.•Surgery was associated with higher baseline ODI; working-age impact was marked (39 % currently work-disabled, +15.5 % in past year), supporting routine psychological/sexual-health screening and targeted occupational rehabilitation.

Heavy burden in lumbar disease: High pain (NRS 7.0), severe disability (ODI 57), 42% depression, and 55% erectile dysfunction.

Disability was independently predicted by higher PHQ-9 scores and older age in men, greater ED severity related to higher disability and older age.

Surgery was associated with higher baseline ODI; working-age impact was marked (39 % currently work-disabled, +15.5 % in past year), supporting routine psychological/sexual-health screening and targeted occupational rehabilitation.