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Objective <p>We assessed whether preoperative advanced multisegmental degeneration is associated with worse&#xa0;1-year outcomes of primary single-level lumbar discectomy.</p> Materials and methods <p>A literature-based scoring system was developed to quantify degeneration in the operated and&#xa0;adjacent lumbar segments, based on advanced phenotypes of common intervertebral disc–related&#xa0;degenerative features. Each segment received a score from 0 to 3: cranial and caudal ≥ 25%&#xa0;endplate damage (EPD) and Modic changes type I (MC1) were assigned 0.5 points each, and&#xa0;Pfirrmann grade ≥ 4 was assigned 1 point. The final adjacent segment degeneration score was&#xa0;calculated as the mean of the operated and adjacent segment scores.&#xa0;Prospectively collected data from primary single-level lumbar discectomy patients operated in a&#xa0;single center between 2017 and 2022 were retrospectively analyzed. Patients were stratified into&#xa0;none-to-mild (≤ 0.5), moderate (0.5 &lt; score &lt; 1.33), and severe (≥ 1.33) degeneration groups, using&#xa0;the 40th and 80th percentile cut-offs. A linear mixed-effects model was employed to assess&#xa0;between-group differences in 1-year improvements in low back (LBP) and leg pain (VAS, 0–100),&#xa0;disability (ODI), and quality of life (EQ-5D-3L).</p> Results <p>Among the 140 patients included (mean age 45.3 years; 57.9% male), all PROMs improved overall.&#xa0;The severe group showed significantly smaller improvements from baseline to 1-year follow-up,&#xa0;with adjusted mean differences in change of 20.2 for LBP, 31.6 for leg pain, and 11.1 for disability&#xa0;relative to the none-to-mild reference group.</p> Conclusion <p>Severe preoperative adjacent segment degeneration may be associated with smaller 1-year&#xa0;improvements in pain and disability after primary single-level lumbar discectomy.</p>

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Adjacent segment degeneration may predict significantly worse leg pain outcomes after lumbar discectomy

  • 期刊论文

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  • 发表日期：

    2026年1月22日

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  • Tero Korhonen,
  • Jyri Järvinen,
  • Juha Pesälä,
  • Marianne Haapea,
  • Juhani Määttä,
  • Jaakko Niinimäki,
  • Pietari Kinnunen

摘要

Objective

We assessed whether preoperative advanced multisegmental degeneration is associated with worse 1-year outcomes of primary single-level lumbar discectomy.

Materials and methods

A literature-based scoring system was developed to quantify degeneration in the operated and adjacent lumbar segments, based on advanced phenotypes of common intervertebral disc–related degenerative features. Each segment received a score from 0 to 3: cranial and caudal ≥ 25% endplate damage (EPD) and Modic changes type I (MC1) were assigned 0.5 points each, and Pfirrmann grade ≥ 4 was assigned 1 point. The final adjacent segment degeneration score was calculated as the mean of the operated and adjacent segment scores. Prospectively collected data from primary single-level lumbar discectomy patients operated in a single center between 2017 and 2022 were retrospectively analyzed. Patients were stratified into none-to-mild (≤ 0.5), moderate (0.5 < score < 1.33), and severe (≥ 1.33) degeneration groups, using the 40th and 80th percentile cut-offs. A linear mixed-effects model was employed to assess between-group differences in 1-year improvements in low back (LBP) and leg pain (VAS, 0–100), disability (ODI), and quality of life (EQ-5D-3L).

Results

Among the 140 patients included (mean age 45.3 years; 57.9% male), all PROMs improved overall. The severe group showed significantly smaller improvements from baseline to 1-year follow-up, with adjusted mean differences in change of 20.2 for LBP, 31.6 for leg pain, and 11.1 for disability relative to the none-to-mild reference group.

Conclusion

Severe preoperative adjacent segment degeneration may be associated with smaller 1-year improvements in pain and disability after primary single-level lumbar discectomy.