ArticleSkeletal radiology2026
Adjacent segment degeneration may predict significantly worse leg pain outcomes after lumbar discectomy.
Article in Skeletal radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveWe assessed whether preoperative advanced multisegmental degeneration is associated with worse 1-year outcomes of primary single-level lumbar discectomy. MATERIALS AND
methodsA 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).
resultsAmong 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.
conclusionSevere preoperative adjacent segment degeneration may be associated with smaller 1-year improvements in pain and disability after primary single-level lumbar discectomy.
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