Central sensitization as a predictor of short-term postoperative outcomes in lumbar spinal stenosis: a prospective observational study

Central sensitization (CS) has been increasingly recognized as a key factor influencing pain perception and recovery in degenerative spinal disorders. This study aimed to investigate whether preoperative CS predicts postoperative outcomes in patients undergoing decompression surgery for lumbar spinal stenosis (LSS). Eighty-six patients with LSS who underwent decompression surgery were prospectively evaluated. CS was assessed using the Central Sensitization Inventory (CSI), with a cutoff score of ≥ 40 defining CS. Visual analogue scale (VAS) pain, Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scale (HADS), and the 12-Item Short Form Health Survey (SF-12) were recorded preoperatively and at three months. Between-group comparisons and multivariate regression analyses were performed to determine the independent effect of CS on postoperative improvement. Patients with CS (54.7%) reported significantly greater baseline pain, disability, and anxiety (all p<0.05). Although both groups improved postoperatively, the magnitude of improvement was smaller in CS+ patients. Between-group differences were significant for reductions in low back pain (p=0.038), leg pain (p=0.003), numbness (p=0.001), disability (p<0.001), and physical quality of life (p<0.001). Regression analyses found that CS independently predicted poorer improvement in disability (β = +22.7, p<0.001), pain (β = +2.3, p<0.001), and physical function (β = −12.4, p<0.001), explaining up to 42% of the variance in postoperative outcomes. Preoperative CS is independently associated with less favorable short-term postoperative recovery following lumbar decompression for LSS. Routine assessment of CS may help identify patients at risk for suboptimal outcomes and guide individualized perioperative management.