Pain catastrophizing and postoperative satisfaction in cervical disc herniation: a 6-month prospective cohort study.

backgroundDespite remarkable technical advancements in cervical minimally invasive interventional therapy, postoperative satisfaction remains suboptimal in a subset of patients with Cervical Disc Herniation (CDH). Pain Catastrophizing (PC), a negative psychological state, has been established as a robust predictor of poor outcomes across various pain-related conditions. However, its specific impact within the context of cervical minimally invasive interventions remains unclear.

objectiveThis study aimed to prospectively investigate the influence of preoperative pain catastrophizing levels on patient satisfaction, pain relief, and functional improvement at 6 months postoperatively in CDH patients undergoing CT-guided percutaneous ozone chemoneurolysis.

methodsThis prospective cohort study consecutively enrolled patients scheduled for minimally invasive interventional treatment for single-level CDH between January 2024 and December 2024. Preoperatively, all patients completed the Pain Catastrophizing Scale (PCS), Visual Analog Scale (VAS) for neck and arm pain, and the Neck Disability Index (NDI). Based on preoperative PCS scores, patients were categorized into a low catastrophizing group (Low-PC, PCS < 30) and a high catastrophizing group (High-PC, PCS ≥ 30). The primary outcome measure was the patient satisfaction rate assessed using the North American Spine Society (NASS) Patient Satisfaction Index at 6 months postoperatively. Secondary outcomes included VAS and NDI scores at 1, 3, and 6 months postoperatively. Multivariable logistic regression analysis was employed to evaluate the independent predictive value of preoperative high PC levels for postoperative dissatisfaction.

resultsUltimately, 118 patients completed the 6-month follow-up and were included in the analysis (Low-PC group: n = 86; High-PC group: n = 32). No significant differences were observed in baseline demographics such as age, gender, and body mass index (BMI) between the two groups (p > 0.05). At the 6-month postoperative mark, the patient satisfaction rate was significantly lower in the High-PC group (46.9%) compared to the Low-PC group (91.9%) (p < 0.001). Although both groups showed significant improvement in VAS and NDI scores postoperatively, the High-PC group demonstrated significantly higher levels of residual neck pain, arm pain, and functional disability at 6 months compared to the Low-PC group (p < 0.01 for all). Multivariable logistic regression analysis identified a preoperative PCS score ≥ 30 as a strong independent predictor of patient dissatisfaction at 6 months (Odds Ratio = 4.5, 95% Confidence Interval [CI]: 1.08–9.78, p < 0.001).

conclusionPreoperative pain catastrophizing is a crucial and modifiable risk factor influencing postoperative satisfaction and clinical efficacy in CDH patients undergoing minimally invasive interventional therapy. Additionally, our analysis identified a longer symptom duration as another independent, exploratory predictor of postoperative dissatisfaction. These findings underscore the importance of integrating psychosocial assessment (particularly using the PCS) and symptom duration evaluation into routine preoperative screening. This practice can aid in identifying high-risk patients, managing patient expectations, and potentially optimizing surgical outcomes through targeted interventions.