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. 2022 Mar 22;38(5):368-380.
doi: 10.1097/AJP.0000000000001033.

Predictors of Pain and Disability Outcomes Following Spinal Surgery for Chronic Low Back and Radicular Pain: A Systematic Review

Monika Halicka  1 , Rui Duarte  2 , Sharon Catherall  3 , Michelle Maden  2 , Michaela Coetsee  1 , Martin Wilby  4 , Christopher Brown  1
Affiliations

Predictors of Pain and Disability Outcomes Following Spinal Surgery for Chronic Low Back and Radicular Pain: A Systematic Review

Monika Halicka et al. Clin J Pain. .

Abstract

Objectives: Success rates of spinal surgeries to treat chronic back pain are highly variable and useable prognostic indicators are lacking. We aimed to identify and evaluate preoperative predictors of pain and disability after spinal surgery for chronic low back/leg pain.

Methods: Electronic database (01/1984-03/2021) and reference searches identified 2622 unique citations. Eligible studies included adults with chronic low back/leg pain lasting ≥3 months undergoing first elective lumbar spine surgery, and outcomes defined as change in pain (primary)/disability (secondary) after ≥3 months. We included 21 reports (6899 participants), 7 were judged to have low and 14 high risks of bias. We performed narrative synthesis and determined the quality of evidence (QoE).

Results: Better pain outcomes were associated with younger age, higher education, and no spinal stenosis (low QoE); lower preoperative pain, fewer comorbidities, lower pain catastrophizing, anxiety and depression (very low QoE); but not with symptom duration (moderate QoE), other sociodemographic factors (low QoE), disability, or sensory testing (very low QoE). More favorable disability outcomes were associated with preoperative sensory loss (moderate QoE); lower job-related resignation and neuroticism (very low QoE); but not with socioeconomic factors, comorbidities (low QoE), demographics, pain, or pain-related psychological factors (very low QoE).

Discussion: In conclusion, absence of spinal stenosis potentially predicts greater pain relief and preoperative sensory loss likely predicts reduction in disability. Overall, QoE for most identified associations was low/very low.

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Conflict of interest statement

This research was funded via the Translational Research Access Programme (TRAP), Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK. The funder approved the objective of this review but had no role in data collection and synthesis, decision to publish, or preparation of the manuscript. The authors declare no conflict of interest.

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