Prevalence and Risk Factors for Persistent Spinal Pain Syndrome Type II Following Spinal Surgery: A Nationwide Retrospective Cohort Study

Background: Persistent Spinal Pain Syndrome Type II (PSPS II) is a major health concern in patients undergoing spinal surgery. However, there are little data on the prevalence and risk factors of PSPS II post spinal surgery. Objectives: We examined the prevalence and factors associated with diagnosing PSPS II post spinal surgery using a nationwide database in the Republic of Korea. Study Design: A retrospective, population-based cohort study. Setting: Nationwide cohort study in the Republic of Korea. Methods: Adult patients who underwent spinal surgery under general anesthesia from January 1, 2016 through December 31, 2020 were included. Patients previously diagnosed with PSPS II were excluded from the study in order to focus only on patients who were newly diagnosed post spinal surgery. We determined that a PSPS II diagnosis must be made within one year of the date of spinal surgery, with an additional evaluation for diagnoses occurring within 2 years to capture longer-term cases. A multivariate logistic regression model was developed to identify the factors associated with diagnosing PSPS II post spinal surgery. Results: In total, 530,644 patients who underwent spinal surgery were included. Of these, 25.6% and 31.5% were diagnosed with PSPS II within one and 2 years post spinal surgery, respectively. The multivariate logistic regression model indicated that being a woman, old age, being a member of a medical aid program group, an increased Charlson Comorbidity Index score, discectomy, laminectomy, and lumbar level surgery were associated with an increased prevalence of PSPS II within one year post spinal surgery. Similar results were observed in the multivariate logistic regression model for PSPS II within 2 years post spinal surgery. Limitation: Our study’s retrospective cohort design is a limitation. Conclusions: This population-based cohort analysis found a 25.6% prevalence of PSPS II within one year post spinal surgery and 31.5% within two years post spinal surgery. Identified risk factors include old age, being a woman, economic poverty, comorbid status, underlying disability, type of surgery, and lumbar-level surgery. A large dataset was used to document the prevalence and risk factors for PSPS II post spinal surgery.