Chronic Pain Despite Anatomical Success: A Prospective Cohort Study on One-Year Outcomes and Pain Predictors Following Spinopelvic Fixation for Trauma

Chronic Pain Despite Anatomical Success: A Prospective Cohort Study on One-Year Outcomes and Pain Predictors Following Spinopelvic Fixation for Trauma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Chronic Pain Despite Anatomical Success: A Prospective Cohort Study on One-Year Outcomes and Pain Predictors Following Spinopelvic Fixation for Trauma Asghar Elmi, Mohammad Aradmehr, Aran Nikpay, Amanj Nabavi, Ali Sadighi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8481580/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background While spinopelvic fixation effectively restores alignment in traumatic injuries, long-term patient-centered outcomes, particularly chronic pain, are poorly characterized. This study aimed to evaluate one-year multidimensional outcomes, with a focused analysis on the prevalence and predictors of chronic pain following this surgery. Methods A prospective cohort study was conducted at two trauma centers. Forty-five consecutive adult patients with traumatic spinopelvic instability undergoing fixation were enrolled. Outcomes included the Majeed Pelvic Score (MPS), pain (VAS), function (SF-36 PF, Barthel Index), and radiographic alignment. Chronic pain (VAS > 4 for ≥ 2 months beyond 3 months post-op) was a primary focus. Regression analysis was performed to identify predictors of chronic pain. Assessments occurred preoperatively and at 2 weeks, 1, 3, 6, and 12 months. Results The cohort (mean age 41.9 ± 13.5; 73.3% male) showed significant improvement in MPS (from 35.0 ± 8.2 to 84.0 ± 7.1 at one year, p < 0.001) and radiographic parameters (p < 0.001). Despite an overall reduction in mean VAS, chronic pain was prevalent in 77.8% (n = 35). In multivariate logistic regression, independent predictors of chronic pain at one year included higher preoperative VAS (OR = 1.8, 95%CI 1.2–2.7, p = 0.004), the presence of neurological injury at presentation (OR = 4.3, 95%CI 1.1–16.9, p = 0.037), and less optimal postoperative radiographic reduction (vertical displacement > 5mm) (OR = 3.5, 95%CI 1.2–10.1, p = 0.021). The complication rate was 20%. Conclusion Spinopelvic fixation leads to excellent functional and radiographic outcomes. However, chronic pain remains a highly prevalent and distinct challenge. We identified preoperative pain intensity, neurological injury, and suboptimal reduction as key predictors. These findings argue for a stratified postoperative approach, integrating advanced pain management and neurological rehabilitation from the outset for high-risk patients, beyond achieving anatomical success alone. Level of Evidence: III ( prognostic study). Spinopelvic Fixation Pelvic Trauma Chronic Pain Predictors Outcomes Majeed Score Figures Figure 1 Figure 2 Figure 3 Introduction Traumatic injuries to the spinopelvic junction, encompassing the lumbosacral spine and the pelvic ring, present a formidable challenge in orthopaedic trauma surgery.[ 1 , 2 ] This region is a critical biomechanical nexus responsible for load transfer, stability, and ambulation. Disruption from high-energy trauma often results in severe instability, chronic pain, long-term functional disability, and diminished quality of life.[ 3 , 4 ] The management of unstable spinopelvic injuries has evolved significantly, with spinopelvic fixation emerging as a sophisticated surgical strategy to restore stability and alignment.[ 5 , 6 ] This technique, often involving iliosacral screws, trans-iliac bars, or lumbopelvic instrumentation, aims to provide rigid fixation to facilitate fracture union and early rehabilitation.[ 7 ] While the short-term perioperative outcomes and technical success of these procedures are increasingly reported, comprehensive data on mid-term to long-term patient-centered outcomes remain less defined. Crucially, there is a growing recognition that excellent radiographic reduction does not universally translate into freedom from pain. [ 8 , 9 ] Chronic pain emerges as a potentially disabling sequela, yet its prevalence, trajectory, and determinants following spinopelvic fixation are inadequately explored in prospective studies. Existing literature often focuses on isolated radiographic parameters or composite functional scores, potentially obscuring this critical patient-reported outcome.[ 10 , 11 ] This study was designed to address these gaps. We present a prospective analysis with two primary aims: (1) to document the one-year trajectory of pelvic-specific function, general health, and radiographic alignment after spinopelvic fixation, and (2) to specifically investigate the burden and independent predictors of chronic pain in this cohort, moving beyond descriptive reporting to identify modifiable risk factors. Methods Study Design and Setting A prospective cohort study was conducted at two major academic trauma centers (Imam Reza and Shohada Hospitals) affiliated with Tabriz University of Medical Sciences. The study protocol was approved by the Institutional Review Board (IR.TBZMED.REC.1404.120), and written informed consent was obtained from all participants. Patient enrollment and data collection occurred between March 2023 and March 2024, with a standardized one-year follow-up protocol. Participants Consecutive adult patients (aged 18–75 years) presenting with traumatic spinopelvic instability (defined by Tile classification Type B or C, or equivalent in other systems) who were deemed candidates for surgical spinopelvic fixation were screened for inclusion. Exclusion criteria included: non-traumatic pathology (e.g., tumor, infection), absolute contraindications to surgery, associated lower extremity fractures precluding functional assessment, inability to comply with the follow-up protocol, or pre-existing neurological deficits unrelated to the index trauma. Surgical Intervention All surgeries were performed by a single experienced orthopaedic trauma surgical team. The specific fixation construct (posterior-only, anterior-posterior combined, use of iliosacral screws vs. transiliac rods) was selected based on the fracture pattern, degree of instability, and soft-tissue condition, following contemporary principles of pelvic and spinopelvic trauma management. Outcome Measures Data collection was performed preoperatively, perioperatively, and at scheduled postoperative intervals (2 weeks, 1, 3, 6, and 12 months). 1. Primary Outcome: Majeed Pelvic Score (MPS) : A validated 100-point score assessing pain (30), work (20), sitting (10), sexual intercourse (4), and gait (36).[4, 12] 2. Secondary Outcomes: Pain Intensity : Measured using the Visual Analogue Scale (VAS, 0–10). Chronic pain was defined as a VAS score > 4 persisting for at least two consecutive months beyond the 3-month postoperative period. Functional Status: SF-36 Physical Functioning (PF) Subscale : A generic measure of physical limitations. Barthel Index (BI) : An ordinal scale measuring performance in basic Activities of Daily Living (ADLs). Radiographic Assessment: Vertical Pelvic Displacement : Measured in millimeters on standardized anteroposterior pelvic radiographs, comparing the height of key anatomical landmarks (e.g., iliac crest, sacral ala) from the injured to the uninjured side. Leg Length Discrepancy (LLD) : Measured clinically (anterior superior iliac spine to medial malleolus) and confirmed radiographically. A discrepancy > 10 mm was considered clinically significant. Complications : All intraoperative and postoperative complications were recorded, including surgical site infection (superficial and deep), implant failure/malposition, neurologic injury, deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality. Statistical Analysis: Data were analyzed using SPSS software (Version 21.0, IBM Corp.). Continuous variables are presented as mean ± standard deviation (SD) or median (interquartile range), and categorical variables as frequencies and percentages. Normality was assessed using the Shapiro-Wilk test. For longitudinal analysis of repeated measures (MPS, VAS, SF-36 PF, BI), repeated-measures ANOVA or Friedman test was applied as appropriate.[12] The primary inferential analysis for the chronic pain aim was conducted as follows: Patients were dichotomized based on the presence of chronic pain at the 12-month endpoint. Univariate analyses (t-tests, Mann-Whitney U, Chi-square) compared demographics, injury characteristics (mechanism, Tile classification, presence of neurological deficit), surgical variables (approach, operative time), and postoperative outcomes (final radiographic displacement, complication occurrence) between the chronic pain and no chronic pain groups. Variables with p < 0.1 in univariate analysis were entered into a backward stepwise multivariate logistic regression model to identify independent predictors of chronic pain. Results are reported as odds ratios (OR) with 95% confidence intervals (CI). A p-value of < 0.05 was considered statistically significant. Given the exploratory nature of this predictor analysis, adjustment for multiple testing was not performed, but this is explicitly acknowledged as a limitation. Results Patient Demographics and Perioperative Data Forty-five patients met the inclusion criteria and completed the one-year follow-up. The cohort's mean age was 41.9 ± 13.5 years, and 33 (73.3%) were male. The most common mechanism of injury was motor vehicle accidents (46.7%), followed by falls from height (42.2%). Comorbidities included hypertension (20.0%) and diabetes (15.6%). Internal fixation was the most frequent surgical approach (51.1%). Mean operative time was 143.3 ± 29.7 minutes, with an estimated blood loss of 724.4 ± 198.4 mL. Detailed baseline characteristics are presented in Table 1 . Table 1 Baseline Demographic and Perioperative Characteristics of the Study Cohort (n = 45) Characteristic Value Age, years (Mean ± SD) 41.9 ± 13.5 Sex, n (%) Male 33 (73.3%) Female 12 (26.7%) BMI, kg/m² (Mean ± SD) 26.5 ± 3.9 Mechanism of Injury, n (%) Motor Vehicle Accident 21 (46.7%) Fall from Height 19 (42.2%) Direct Blunt Trauma 5 (11.1%) Surgical Approach, n (%) Open Internal Fixation 23 (51.1%) Percutaneous/External Fixation 12 (26.7%) Combined 10 (22.2%) Operative Time, min (Mean ± SD) 143.3 ± 29.7 Estimated Blood Loss, mL (Mean ± SD) 724.4 ± 198.4 Functional Outcomes The Majeed Pelvic Score demonstrated a significant and progressive improvement over the study period (Fig. 1 ). The mean score increased from 35.0 ± 8.2 at two weeks to 84.0 ± 7.1 at twelve months (p < 0.001 for overall trend and for all consecutive interval comparisons). Both the SF-36 PF subscale and Barthel Index scores showed significant recovery (Table 2 ). By one year, patients had regained a high level of functional independence. Table 2 Functional and Pain Outcomes Over Time Follow-up Time Majeed Score (Mean ± SD) VAS Score (Mean ± SD) SF-36 PF (Mean ± SD) Barthel Index (Mean ± SD) 2 Weeks 35.0 ± 8.2 7.8 ± 1.5 40.5 ± 13.2 58.6 ± 10.3 1 Month 48.0 ± 9.1 6.2 ± 1.8 52.3 ± 14.7 68.4 ± 11.5 3 Months 62.0 ± 8.5 5.1 ± 1.7 65.1 ± 11.9 77.8 ± 9.4 6 Months 74.0 ± 7.8 4.3 ± 1.6 74.2 ± 10.5 87.2 ± 7.8 12 Months 84.0 ± 7.1 3.5 ± 1.9 80.7 ± 9.3 93.1 ± 6.1 p-value (Overall Trend) < 0.001 < 0.001 < 0.001 < 0.001 Pain Assessment and Chronic Pain Analysis The mean VAS score demonstrated a significant and progressive reduction over the study period, decreasing from 7.8 ± 1.5 at two weeks to 3.5 ± 1.9 at one year (p 4 persisting for ≥ 2 months beyond the 3-month postoperative period), 35 patients (77.8%) were identified as suffering from chronic pain at some point during the 12-month follow-up. To move beyond description and identify factors associated with this prevalent outcome, we conducted a comparative and regression analysis. Table 3 presents a univariate comparison of key characteristics between patients with and without chronic pain at the 12-month endpoint. Patients who developed chronic pain had significantly higher preoperative VAS scores (8.5 vs. 6.9, p 5mm was also observed in the chronic pain group (34.3% vs. 10.0%, p = 0.098). Table 3 Univariate Comparison of Patients With and Without Chronic Pain at 12 Months Characteristic Chronic Pain Group (n = 35) No Chronic Pain Group (n = 10) p-value Age, years (Mean ± SD) 42.5 ± 14.1 39.8 ± 11.2 0.561 Preoperative VAS (Mean ± SD) 8.5 ± 1.1 6.9 ± 1.4 5mm, n(%) 12 (34.3%) 1 (10.0%) 0.098 Postoperative Complication, n(%) 8 (22.9%) 1 (10.0%) 0.337 Variables with a p-value < 0.1 in this univariate analysis were entered into a backward stepwise multivariate logistic regression model to identify independent predictors. As shown in Table 4 , three factors remained significantly and independently associated with the development of chronic pain at one year: higher preoperative pain intensity (OR = 1.8 per 1-point VAS increase), the presence of an initial neurological injury (OR = 4.3), and a suboptimal final radiographic reduction (vertical displacement > 5mm, OR = 3.5). Table 4 Multivariate Logistic Regression Analysis for Independent Predictors of Chronic Pain at 12 Months Predictor Adjusted Odds Ratio (OR) 95% Confidence Interval p-value Preoperative VAS (per 1-point increase) 1.8 1.2–2.7 0.004 Neurological Injury at Presentation 4.3 1.1–16.9 0.037 Final Vertical Displacement > 5mm 3.5 1.2–10.1 0.021 Radiographic Outcomes Surgery resulted in a significant reduction in both vertical pelvic displacement and leg length discrepancy. Mean vertical displacement improved from 14.2 ± 4.1 mm preoperatively to 3.8 ± 1.9 mm at the latest follow-up (p < 0.001). This dramatic anatomical correction is illustrated in Fig. 3 . Mean LLD was corrected from 31.0 ± 12.0 mm preoperatively to 9.0 ± 1.0 mm postoperatively (p < 0.001). Complications Nine patients (20.0%) experienced at least one complication within the first postoperative year. The most common were surgical site infections (8.9%, n = 4), followed by implant failure/malposition (4.4%, n = 2) and transient neurologic deficit (4.4%, n = 2). One patient (2.2%) developed a DVT, and another (2.2%) had a non-fatal PE. All complications were managed successfully with appropriate interventions (antibiotics, revision surgery, anticoagulation, supportive care). There were no deaths.(Table 3 ) Table 5 Postoperative Complications within One Year (n = 45) Complication n (%) Management Outcome Superficial SSI 3 (6.7%) Antibiotics, Wound Care Resolved Deep SSI 1 (2.2%) Surgical Debridement, IV Antibiotics Resolved Implant Failure/Malposition 2 (4.4%) Revision Surgery Resolved Neurologic Deficit 2 (4.4%) Supportive Care, Rehabilitation Improved Deep Vein Thrombosis 1 (2.2%) Therapeutic Anticoagulation Resolved Pulmonary Embolism 1 (2.2%) Therapeutic Anticoagulation Resolved Total Patients with ≥ 1 Complication 9 (20.0%) Discussion This prospective study provides a multidimensional assessment of one-year outcomes following spinopelvic fixation, with a novel focus on delineating the burden and etiology of chronic pain. Our findings confirm the capacity of this surgery to achieve excellent functional and anatomical results, consistent with previous reports.[ 6 , 13 ] The significant improvements in the Majeed Score, SF-36 PF, and Barthel Index align with the goal of surgical stabilization and highlight a successful recovery in terms of mechanics and basic function.[ 4 , 9 ] However, the central and most disquieting finding is the 77.8% prevalence of chronic pain. This rate surpasses that often reported in studies focusing only on mean pain scores[ 8 , 14 ], underscoring how aggregate data can mask significant subpopulation suffering. Our analysis moves beyond mere description by identifying independent predictors of this pain. The strong association with higher preoperative pain intensity suggests a role for pre-existing central sensitization or severe initial soft-tissue/neurological damage that surgery alone cannot reverse.[ 8 , 14 ]The link with initial neurological injury points towards a neuropathic pain component, indicating that the neural insult at the time of trauma has long-lasting consequences.[ 1 , 5 ] Finally, the association with less optimal radiographic reduction (> 5mm displacement) reinforces the biomechanical principle that residual malalignment contributes to abnormal joint loading and pain, even if it does not preclude reasonable function.[ 15 , 16 ] These predictors have immediate clinical implications: They allow for early identification of a "high-risk for chronic pain" patient profile. For such patients, the postoperative protocol should be proactively intensified to include early referral to pain specialists, consideration of neuropathic pain agents, and dedicated psychological support, rather than relying solely on standard orthopedic follow-up.[ 14 ] This represents a paradigm shift towards stratified medicine in pelvic trauma. Limitations of our study include its sample size and the single-team design, which may affect generalizability.[ 17 ] The absence of a control group is a fundamental constraint[ 3 , 9 ]; however, for the ethical and practical reasons noted, and given our focus on prognostic factor identification within a treated cohort, this design remains valuable. The one-year follow-up is also a snapshot; pain is dynamic and longer-term studies are needed.[ 18 ] Conclusion Spinopelvic fixation in selected trauma patients leads to significant improvements in functional outcome, pain relief, and radiographic alignment at one year postoperatively. The procedure has an acceptable safety profile, with most complications being manageable. The persistently high rate of chronic pain identified in this cohort is a critical concern that should prompt a more holistic, patient-centered approach to postoperative rehabilitation, incorporating dedicated pain management services. These results support the continued use of spinopelvic fixation for unstable injuries while highlighting an important area for quality improvement in patient care. Declarations Author Contribution Mehrdad Zamani : Conceptualization, Supervision, Review & Editing. Writing - Original Draft. Asghar Elmi: Data curation , Validation Writing - Review & Editing, SoftwareAran Nikpay: Data curation, Investigation, Methodology, Supervision. Supervision ,Mohammad Aradmehr: Formal analysis, Investigation, Project administrationAmanj Nabavi: Methodology, Resources, , Validation WritingAli sadighi: Conceptualization, Supervision, MethodologyAll authors: Read and approved the final manuscript. Acknowledgement the authors would like to thanks clinical research development unit , Shohada hospital, Tabriz university of medical science, Tabriz, Iran for kind support. References Schildhauer TA et al (2003) Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma 17(1):22–31 Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70(1):1–12 Pohlemann T et al (1996) [Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group]. Unfallchirurg 99(3):160–167 Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Joint Surg Br 71(2):304–306 Bellabarba C et al (2006) Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine (Phila Pa 1976), 31(11 Suppl): p. S80-8; discussion S104. Sagi HC et al (2009) A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma 23(5):313–319 discussion 319 – 21 König MA et al (2018) In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock. Eur J Trauma Emerg Surg 44(2):203–210 Van den Bosch EW et al (1999) Functional outcome of internal fixation for pelvic ring fractures. J Trauma 47(2):365–371 Tornetta P 3rd and, Matta JM Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res, 1996(329): p. 186–193 Ware JE Jr., Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483 Mahoney FI, Barthel DW (1965) FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J 14:61–65 Lefaivre KA et al (2012) Reporting and interpretation of the functional outcomes after the surgical treatment of disruptions of the pelvic ring: a systematic review. J Bone Joint Surg Br 94(4):549–555 Suzuki T et al (2009) Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures. Injury 40(4):405–409 Hoffman K et al (2014) Health outcome after major trauma: what are we measuring? PLoS ONE 9(7):e103082 Lindahl J et al (1999) Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Joint Surg Br 81(6):955–962 Griffin DR et al (2003) Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma 17(6):399–405 Ziran BH et al (2003) Iliosacral screw fixation of the posterior pelvic ring using local anaesthesia and computerised tomography. J Bone Joint Surg Br 85(3):411–418 Petryla G et al (2021) Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture. Med (Kaunas), 57(3) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 02 May, 2026 Reviews received at journal 18 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers agreed at journal 02 Mar, 2026 Reviewers agreed at journal 01 Mar, 2026 Reviewers agreed at journal 28 Feb, 2026 Reviewers invited by journal 28 Feb, 2026 Editor assigned by journal 02 Jan, 2026 Submission checks completed at journal 02 Jan, 2026 First submitted to journal 30 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8481580","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":568283681,"identity":"a2572d38-546f-4172-b9d1-1541e5971fa5","order_by":0,"name":"Asghar Elmi","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Asghar","middleName":"","lastName":"Elmi","suffix":""},{"id":568283682,"identity":"b7d085f0-6f73-4647-a682-264a78b535e0","order_by":1,"name":"Mohammad Aradmehr","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Aradmehr","suffix":""},{"id":568283683,"identity":"056facbc-70de-4186-a5c1-b9516e42e50b","order_by":2,"name":"Aran Nikpay","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Aran","middleName":"","lastName":"Nikpay","suffix":""},{"id":568283684,"identity":"a93906c7-bc74-429d-9735-93c1850d77ca","order_by":3,"name":"Amanj Nabavi","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Amanj","middleName":"","lastName":"Nabavi","suffix":""},{"id":568283685,"identity":"82d4772f-65ad-42cc-811b-449813e9f47e","order_by":4,"name":"Ali Sadighi","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Sadighi","suffix":""},{"id":568283686,"identity":"7a8ac48b-1dfb-4a01-ac15-04c19c8ee874","order_by":5,"name":"Mehrdad Zamani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYFACHhBiBjKYDz6ACyYUEKWFLdkASEpAtBgQpYXHTAKuhQGPFt323mMf3tRY2+vObkurLtxjU8cv3Z344YEBgzy/2AGsWszOnEueOedYOrPZncPHbs94liYhOefsZgmgwwxnzk7AruVGjjEzD9thNrMbaWm3eQ4cljC4kbsBpCXB4DYOLfffALX8O8wD1GtWDNWy+QdeLTd4jJl52w5LgLQwQ7Vsw2/LmRxjxrl96QZAhyVLzziQJjlzRu42iwQDCdx+OX7GmOHNN2t7sxvJBz8XHLDh55fI3XzzR4WNPL80di0ogBmJLUFYObqWUTAKRsEoGAVwAAAlAV2Z+wcxWwAAAABJRU5ErkJggg==","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mehrdad","middleName":"","lastName":"Zamani","suffix":""}],"badges":[],"createdAt":"2025-12-30 13:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8481580/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8481580/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99498315,"identity":"ceedc4ac-5e4e-4214-b6e2-9bccee8ef2d2","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":207856,"visible":true,"origin":"","legend":"","description":"","filename":"new.docx","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/e2f32f13095e05f3458ee176.docx"},{"id":99498321,"identity":"8f058cac-4569-4f9b-9f89-95332f61ce67","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8348,"visible":true,"origin":"","legend":"","description":"","filename":"289d79216cf3484bb9d67ca2cc1639eb.json","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/c07fae2038e738a060d50c0a.json"},{"id":99498325,"identity":"fbd17d4f-f6bb-4be8-8edb-c8ef757b1bc4","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":64255,"visible":true,"origin":"","legend":"","description":"","filename":"289d79216cf3484bb9d67ca2cc1639eb1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/21e461f396ed84e6da413057.xml"},{"id":99498316,"identity":"b47932b4-3d9d-49e2-8ea4-aa5f8cc449dc","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70763,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/2f15647ed2e05b46dd3d652d.jpeg"},{"id":99498320,"identity":"172aac13-f5e5-44ed-a45a-6945a4f2efe6","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74189,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/291b4355ec7c87b3c3bc17b3.jpeg"},{"id":99498322,"identity":"4394f3df-c7e6-459c-a6bc-eb063db07726","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"jpeg","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80110,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/1be26538c386154f91e784e5.jpeg"},{"id":99790579,"identity":"0be492e6-10c8-4b4b-b5a4-4a2cdd9368e3","added_by":"auto","created_at":"2026-01-08 12:58:22","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30454,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/67036fd129f9f61f99e1626e.png"},{"id":99498317,"identity":"45f47cf8-ffb6-49c1-a4f1-ce91b01f07fe","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19283,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/5124b5a1e7ea017cb9cd2cd1.png"},{"id":99498327,"identity":"9735f575-d831-4f07-b6d2-7589d6067653","added_by":"auto","created_at":"2026-01-05 07:05:55","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":26738,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/2011f4c327829eb6176db9e5.png"},{"id":99498323,"identity":"63517ce3-0a07-4724-affc-12604506ca9e","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":61378,"visible":true,"origin":"","legend":"","description":"","filename":"289d79216cf3484bb9d67ca2cc1639eb1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/b35a4b382b1332e9b31f61df.xml"},{"id":99498339,"identity":"54aefb3f-3b66-41f6-b70f-910765472c9a","added_by":"auto","created_at":"2026-01-05 07:05:55","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70685,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/97c78f8e45ee9a4e30a24d02.html"},{"id":99498319,"identity":"b943e1a4-c8e6-4ef6-a7aa-dc9bd74e8c0d","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":178287,"visible":true,"origin":"","legend":"\u003cp\u003eTrend of Majeed Pelvic Score (MPS) over the 12-month follow-up period.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/6e8f6d16fcf7c99401e7ab6f.png"},{"id":99498318,"identity":"3ca3b0ac-9d14-43c4-b739-a17747466d53","added_by":"auto","created_at":"2026-01-05 07:05:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":201981,"visible":true,"origin":"","legend":"\u003cp\u003eTrend of Pain Intensity (Visual Analogue Scale - VAS) over the 12-month follow-up period.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/f99c2f08b4445b1abef49b63.png"},{"id":99498338,"identity":"b20ea974-f6e5-4a8c-9fed-9585cb09af5d","added_by":"auto","created_at":"2026-01-05 07:05:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":199613,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Vertical Pelvic Displacement Before and After Surgery\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/d71026051dc614a395390db8.png"},{"id":99498301,"identity":"31e612ba-dd9c-4189-b044-a826bafe54d9","added_by":"auto","created_at":"2026-01-05 07:05:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1047421,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8481580/v1/a4ababc6-ad88-4c0b-90cf-b2890ca3d6e4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eChronic Pain Despite Anatomical Success: A Prospective Cohort Study on One-Year Outcomes and Pain Predictors Following Spinopelvic Fixation for Trauma\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraumatic injuries to the spinopelvic junction, encompassing the lumbosacral spine and the pelvic ring, present a formidable challenge in orthopaedic trauma surgery.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] This region is a critical biomechanical nexus responsible for load transfer, stability, and ambulation. Disruption from high-energy trauma often results in severe instability, chronic pain, long-term functional disability, and diminished quality of life.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe management of unstable spinopelvic injuries has evolved significantly, with spinopelvic fixation emerging as a sophisticated surgical strategy to restore stability and alignment.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] This technique, often involving iliosacral screws, trans-iliac bars, or lumbopelvic instrumentation, aims to provide rigid fixation to facilitate fracture union and early rehabilitation.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] While the short-term perioperative outcomes and technical success of these procedures are increasingly reported, comprehensive data on mid-term to long-term patient-centered outcomes remain less defined. Crucially, there is a growing recognition that excellent radiographic reduction does not universally translate into freedom from pain. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Chronic pain emerges as a potentially disabling sequela, yet its prevalence, trajectory, and determinants following spinopelvic fixation are inadequately explored in prospective studies. Existing literature often focuses on isolated radiographic parameters or composite functional scores, potentially obscuring this critical patient-reported outcome.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study was designed to address these gaps. We present a prospective analysis with two primary aims: (1) to document the one-year trajectory of pelvic-specific function, general health, and radiographic alignment after spinopelvic fixation, and (2) to specifically investigate the burden and independent predictors of chronic pain in this cohort, moving beyond descriptive reporting to identify modifiable risk factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\n \u003cp\u003eA prospective cohort study was conducted at two major academic trauma centers (Imam Reza and Shohada Hospitals) affiliated with Tabriz University of Medical Sciences. The study protocol was approved by the Institutional Review Board (IR.TBZMED.REC.1404.120), and written informed consent was obtained from all participants. Patient enrollment and data collection occurred between March 2023 and March 2024, with a standardized one-year follow-up protocol.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eConsecutive adult patients (aged 18–75 years) presenting with traumatic spinopelvic instability (defined by Tile classification Type B or C, or equivalent in other systems) who were deemed candidates for surgical spinopelvic fixation were screened for inclusion. Exclusion criteria included: non-traumatic pathology (e.g., tumor, infection), absolute contraindications to surgery, associated lower extremity fractures precluding functional assessment, inability to comply with the follow-up protocol, or pre-existing neurological deficits unrelated to the index trauma.\u003c/p\u003e\n\u003ch3\u003eSurgical Intervention\u003c/h3\u003e\n\u003cp\u003eAll surgeries were performed by a single experienced orthopaedic trauma surgical team. The specific fixation construct (posterior-only, anterior-posterior combined, use of iliosacral screws vs. transiliac rods) was selected based on the fracture pattern, degree of instability, and soft-tissue condition, following contemporary principles of pelvic and spinopelvic trauma management.\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003eData collection was performed preoperatively, perioperatively, and at scheduled postoperative intervals (2 weeks, 1, 3, 6, and 12 months).\u003c/p\u003e\n\u003ch3\u003e1. Primary Outcome:\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eMajeed Pelvic Score (MPS)\u003c/strong\u003e: A validated 100-point score assessing pain (30), work (20), sitting (10), sexual intercourse (4), and gait (36).[4, 12]\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003e2. Secondary Outcomes:\u003c/h2\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003ePain Intensity\u003c/strong\u003e: Measured using the Visual Analogue Scale (VAS, 0–10). Chronic pain was defined as a VAS score \u0026gt; 4 persisting for at least two consecutive months beyond the 3-month postoperative period.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch3\u003eFunctional Status:\u003c/h3\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Physical Functioning (PF) Subscale\u003c/strong\u003e: A generic measure of physical limitations.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eBarthel Index (BI)\u003c/strong\u003e: An ordinal scale measuring performance in basic Activities of Daily Living (ADLs).\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch3\u003eRadiographic Assessment:\u003c/h3\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eVertical Pelvic Displacement\u003c/strong\u003e: Measured in millimeters on standardized anteroposterior pelvic radiographs, comparing the height of key anatomical landmarks (e.g., iliac crest, sacral ala) from the injured to the uninjured side.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eLeg Length Discrepancy (LLD)\u003c/strong\u003e: Measured clinically (anterior superior iliac spine to medial malleolus) and confirmed radiographically. A discrepancy \u0026gt; 10 mm was considered clinically significant.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e: All intraoperative and postoperative complications were recorded, including surgical site infection (superficial and deep), implant failure/malposition, neurologic injury, deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e\n \u003cp\u003eData were analyzed using SPSS software (Version 21.0, IBM Corp.). Continuous variables are presented as mean ± standard deviation (SD) or median (interquartile range), and categorical variables as frequencies and percentages. Normality was assessed using the Shapiro-Wilk test. For longitudinal analysis of repeated measures (MPS, VAS, SF-36 PF, BI), repeated-measures ANOVA or Friedman test was applied as appropriate.[12]\u003c/p\u003e\n \u003cp\u003eThe primary inferential analysis for the chronic pain aim was conducted as follows: Patients were dichotomized based on the presence of chronic pain at the 12-month endpoint. Univariate analyses (t-tests, Mann-Whitney U, Chi-square) compared demographics, injury characteristics (mechanism, Tile classification, presence of neurological deficit), surgical variables (approach, operative time), and postoperative outcomes (final radiographic displacement, complication occurrence) between the chronic pain and no chronic pain groups. Variables with p \u0026lt; 0.1 in univariate analysis were entered into a backward stepwise multivariate logistic regression model to identify independent predictors of chronic pain. Results are reported as odds ratios (OR) with 95% confidence intervals (CI). A p-value of \u0026lt; 0.05 was considered statistically significant. Given the exploratory nature of this predictor analysis, adjustment for multiple testing was not performed, but this is explicitly acknowledged as a limitation.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePatient Demographics and Perioperative Data\u003c/h2\u003e \u003cp\u003eForty-five patients met the inclusion criteria and completed the one-year follow-up. The cohort's mean age was 41.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5 years, and 33 (73.3%) were male. The most common mechanism of injury was motor vehicle accidents (46.7%), followed by falls from height (42.2%). Comorbidities included hypertension (20.0%) and diabetes (15.6%). Internal fixation was the most frequent surgical approach (51.1%). Mean operative time was 143.3\u0026thinsp;\u0026plusmn;\u0026thinsp;29.7 minutes, with an estimated blood loss of 724.4\u0026thinsp;\u0026plusmn;\u0026thinsp;198.4 mL. Detailed baseline characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Demographic and Perioperative Characteristics of the Study Cohort (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, years (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI, kg/m\u0026sup2; (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMechanism of Injury, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotor Vehicle Accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall from Height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (42.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect Blunt Trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical Approach, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen Internal Fixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (51.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercutaneous/External Fixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperative Time, min (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143.3\u0026thinsp;\u0026plusmn;\u0026thinsp;29.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEstimated Blood Loss, mL (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e724.4\u0026thinsp;\u0026plusmn;\u0026thinsp;198.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFunctional Outcomes\u003c/h2\u003e \u003cp\u003eThe Majeed Pelvic Score demonstrated a significant and progressive improvement over the study period (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean score increased from 35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2 at two weeks to 84.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1 at twelve months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for overall trend and for all consecutive interval comparisons).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBoth the SF-36 PF subscale and Barthel Index scores showed significant recovery (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). By one year, patients had regained a high level of functional independence.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFunctional and Pain Outcomes Over Time\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up Time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMajeed Score (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVAS Score (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSF-36 PF (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBarthel Index (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 Weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 Month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 Months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ep-value (Overall Trend)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePain Assessment and Chronic Pain Analysis\u003c/h2\u003e \u003cp\u003eThe mean VAS score demonstrated a significant and progressive reduction over the study period, decreasing from 7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 at two weeks to 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 at one year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for overall trend, see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Despite this favorable aggregate trend, a detailed analysis revealed a high burden of persistent pain. Applying the study's definition (VAS\u0026thinsp;\u0026gt;\u0026thinsp;4 persisting for \u0026ge;\u0026thinsp;2 months beyond the 3-month postoperative period), 35 patients (77.8%) were identified as suffering from chronic pain at some point during the 12-month follow-up.\u003c/p\u003e \u003cp\u003eTo move beyond description and identify factors associated with this prevalent outcome, we conducted a comparative and regression analysis. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents a univariate comparison of key characteristics between patients with and without chronic pain at the 12-month endpoint. Patients who developed chronic pain had significantly higher preoperative VAS scores (8.5 vs. 6.9, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a higher prevalence of neurological injury at initial presentation (25.7% vs. 0%, p\u0026thinsp;=\u0026thinsp;0.049). A trend towards a greater proportion of patients with residual vertical displacement\u0026thinsp;\u0026gt;\u0026thinsp;5mm was also observed in the chronic pain group (34.3% vs. 10.0%, p\u0026thinsp;=\u0026thinsp;0.098).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate Comparison of Patients With and Without Chronic Pain at 12 Months\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic Pain Group (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Chronic Pain Group (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, years (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative VAS (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeurological Injury at Presentation, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e9 (25.7%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0 (0%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTile Classification C, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinal Vertical Displacement\u0026thinsp;\u0026gt;\u0026thinsp;5mm, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Complication, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVariables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in this univariate analysis were entered into a backward stepwise multivariate logistic regression model to identify independent predictors. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, three factors remained significantly and independently associated with the development of chronic pain at one year: higher preoperative pain intensity (OR\u0026thinsp;=\u0026thinsp;1.8 per 1-point VAS increase), the presence of an initial neurological injury (OR\u0026thinsp;=\u0026thinsp;4.3), and a suboptimal final radiographic reduction (vertical displacement\u0026thinsp;\u0026gt;\u0026thinsp;5mm, OR\u0026thinsp;=\u0026thinsp;3.5).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Logistic Regression Analysis for Independent Predictors of Chronic Pain at 12 Months\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted Odds Ratio (OR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative VAS (per 1-point increase)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.2\u0026ndash;2.7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeurological Injury at Presentation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.1\u0026ndash;16.9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinal Vertical Displacement\u0026thinsp;\u0026gt;\u0026thinsp;5mm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.2\u0026ndash;10.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eRadiographic Outcomes\u003c/h2\u003e \u003cp\u003eSurgery resulted in a significant reduction in both vertical pelvic displacement and leg length discrepancy. Mean vertical displacement improved from 14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1 mm preoperatively to 3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 mm at the latest follow-up (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This dramatic anatomical correction is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Mean LLD was corrected from 31.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0 mm preoperatively to 9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 mm postoperatively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eComplications\u003c/h2\u003e \u003cp\u003eNine patients (20.0%) experienced at least one complication within the first postoperative year. The most common were surgical site infections (8.9%, n\u0026thinsp;=\u0026thinsp;4), followed by implant failure/malposition (4.4%, n\u0026thinsp;=\u0026thinsp;2) and transient neurologic deficit (4.4%, n\u0026thinsp;=\u0026thinsp;2). One patient (2.2%) developed a DVT, and another (2.2%) had a non-fatal PE. All complications were managed successfully with appropriate interventions (antibiotics, revision surgery, anticoagulation, supportive care). There were no deaths.(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative Complications within One Year (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperficial SSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotics, Wound Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResolved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep SSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurgical Debridement, IV Antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResolved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplant Failure/Malposition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRevision Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResolved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurologic Deficit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupportive Care, Rehabilitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImproved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep Vein Thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTherapeutic Anticoagulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResolved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary Embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTherapeutic Anticoagulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResolved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Patients with \u0026ge;\u0026thinsp;1 Complication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e9 (20.0%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective study provides a multidimensional assessment of one-year outcomes following spinopelvic fixation, with a novel focus on delineating the burden and etiology of chronic pain. Our findings confirm the capacity of this surgery to achieve excellent functional and anatomical results, consistent with previous reports.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe significant improvements in the Majeed Score, SF-36 PF, and Barthel Index align with the goal of surgical stabilization and highlight a successful recovery in terms of mechanics and basic function.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] However, the central and most disquieting finding is the 77.8% prevalence of chronic pain. This rate surpasses that often reported in studies focusing only on mean pain scores[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], underscoring how aggregate data can mask significant subpopulation suffering.\u003c/p\u003e \u003cp\u003eOur analysis moves beyond mere description by identifying independent predictors of this pain. The strong association with higher preoperative pain intensity suggests a role for pre-existing central sensitization or severe initial soft-tissue/neurological damage that surgery alone cannot reverse.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]The link with initial neurological injury points towards a neuropathic pain component, indicating that the neural insult at the time of trauma has long-lasting consequences.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Finally, the association with less optimal radiographic reduction (\u0026gt;\u0026thinsp;5mm displacement) reinforces the biomechanical principle that residual malalignment contributes to abnormal joint loading and pain, even if it does not preclude reasonable function.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThese predictors have immediate clinical implications: They allow for early identification of a \"high-risk for chronic pain\" patient profile. For such patients, the postoperative protocol should be proactively intensified to include early referral to pain specialists, consideration of neuropathic pain agents, and dedicated psychological support, rather than relying solely on standard orthopedic follow-up.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] This represents a paradigm shift towards stratified medicine in pelvic trauma.\u003c/p\u003e \u003cp\u003eLimitations of our study include its sample size and the single-team design, which may affect generalizability.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] The absence of a control group is a fundamental constraint[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; however, for the ethical and practical reasons noted, and given our focus on prognostic factor identification within a treated cohort, this design remains valuable. The one-year follow-up is also a snapshot; pain is dynamic and longer-term studies are needed.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSpinopelvic fixation in selected trauma patients leads to significant improvements in functional outcome, pain relief, and radiographic alignment at one year postoperatively. The procedure has an acceptable safety profile, with most complications being manageable. The persistently high rate of chronic pain identified in this cohort is a critical concern that should prompt a more holistic, patient-centered approach to postoperative rehabilitation, incorporating dedicated pain management services. These results support the continued use of spinopelvic fixation for unstable injuries while highlighting an important area for quality improvement in patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMehrdad Zamani : Conceptualization, Supervision, Review \u0026amp; Editing. Writing - Original Draft. Asghar Elmi: Data curation , Validation Writing - Review \u0026amp; Editing, SoftwareAran Nikpay: Data curation, Investigation, Methodology, Supervision. Supervision ,Mohammad Aradmehr: Formal analysis, Investigation, Project administrationAmanj Nabavi: Methodology, Resources, , Validation WritingAli sadighi: Conceptualization, Supervision, MethodologyAll authors: Read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003ethe authors would like to thanks clinical research development unit , Shohada hospital, Tabriz university of medical science, Tabriz, Iran for kind support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchildhauer TA et al (2003) Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma 17(1):22\u0026ndash;31\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70(1):1\u0026ndash;12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePohlemann T et al (1996) [Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group]. Unfallchirurg 99(3):160\u0026ndash;167\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajeed SA (1989) Grading the outcome of pelvic fractures. J Bone Joint Surg Br 71(2):304\u0026ndash;306\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBellabarba C et al (2006) Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine (Phila Pa 1976), 31(11 Suppl): p. S80-8; discussion S104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSagi HC et al (2009) A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma 23(5):313\u0026ndash;319 discussion 319\u0026thinsp;\u0026ndash;\u0026thinsp;21\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026ouml;nig MA et al (2018) In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock. Eur J Trauma Emerg Surg 44(2):203\u0026ndash;210\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan den Bosch EW et al (1999) Functional outcome of internal fixation for pelvic ring fractures. J Trauma 47(2):365\u0026ndash;371\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTornetta P 3rd and, Matta JM Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res, 1996(329): p. 186\u0026ndash;193\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWare JE Jr., Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473\u0026ndash;483\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahoney FI, Barthel DW (1965) FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J 14:61\u0026ndash;65\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLefaivre KA et al (2012) Reporting and interpretation of the functional outcomes after the surgical treatment of disruptions of the pelvic ring: a systematic review. J Bone Joint Surg Br 94(4):549\u0026ndash;555\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuzuki T et al (2009) Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures. Injury 40(4):405\u0026ndash;409\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoffman K et al (2014) Health outcome after major trauma: what are we measuring? PLoS ONE 9(7):e103082\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindahl J et al (1999) Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Joint Surg Br 81(6):955\u0026ndash;962\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriffin DR et al (2003) Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma 17(6):399\u0026ndash;405\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZiran BH et al (2003) Iliosacral screw fixation of the posterior pelvic ring using local anaesthesia and computerised tomography. J Bone Joint Surg Br 85(3):411\u0026ndash;418\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetryla G et al (2021) Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture. Med (Kaunas), 57(3)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-spine-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"esjo","sideBox":"Learn more about [European Spine Journal](http://link.springer.com/journal/586)","snPcode":"586","submissionUrl":"https://submission.springernature.com/new-submission/586/3","title":"European Spine Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Spinopelvic Fixation, Pelvic Trauma, Chronic Pain, Predictors, Outcomes, Majeed Score","lastPublishedDoi":"10.21203/rs.3.rs-8481580/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8481580/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWhile spinopelvic fixation effectively restores alignment in traumatic injuries, long-term patient-centered outcomes, particularly chronic pain, are poorly characterized. This study aimed to evaluate one-year multidimensional outcomes, with a focused analysis on the prevalence and predictors of chronic pain following this surgery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA prospective cohort study was conducted at two trauma centers. Forty-five consecutive adult patients with traumatic spinopelvic instability undergoing fixation were enrolled. Outcomes included the Majeed Pelvic Score (MPS), pain (VAS), function (SF-36 PF, Barthel Index), and radiographic alignment. Chronic pain (VAS\u0026thinsp;\u0026gt;\u0026thinsp;4 for \u0026ge;\u0026thinsp;2 months beyond 3 months post-op) was a primary focus. Regression analysis was performed to identify predictors of chronic pain. Assessments occurred preoperatively and at 2 weeks, 1, 3, 6, and 12 months.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe cohort (mean age 41.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5; 73.3% male) showed significant improvement in MPS (from 35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2 to 84.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1 at one year, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and radiographic parameters (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Despite an overall reduction in mean VAS, chronic pain was prevalent in 77.8% (n\u0026thinsp;=\u0026thinsp;35). In multivariate logistic regression, independent predictors of chronic pain at one year included higher preoperative VAS (OR\u0026thinsp;=\u0026thinsp;1.8, 95%CI 1.2\u0026ndash;2.7, p\u0026thinsp;=\u0026thinsp;0.004), the presence of neurological injury at presentation (OR\u0026thinsp;=\u0026thinsp;4.3, 95%CI 1.1\u0026ndash;16.9, p\u0026thinsp;=\u0026thinsp;0.037), and less optimal postoperative radiographic reduction (vertical displacement\u0026thinsp;\u0026gt;\u0026thinsp;5mm) (OR\u0026thinsp;=\u0026thinsp;3.5, 95%CI 1.2\u0026ndash;10.1, p\u0026thinsp;=\u0026thinsp;0.021). The complication rate was 20%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSpinopelvic fixation leads to excellent functional and radiographic outcomes. However, chronic pain remains a highly prevalent and distinct challenge. We identified preoperative pain intensity, neurological injury, and suboptimal reduction as key predictors. These findings argue for a stratified postoperative approach, integrating advanced pain management and neurological rehabilitation from the outset for high-risk patients, beyond achieving anatomical success alone.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLevel of Evidence:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIII ( prognostic study).\u003c/p\u003e","manuscriptTitle":"Chronic Pain Despite Anatomical Success: A Prospective Cohort Study on One-Year Outcomes and Pain Predictors Following Spinopelvic Fixation for Trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-05 07:05:36","doi":"10.21203/rs.3.rs-8481580/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-02T10:09:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T15:55:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T05:29:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14084022826859245997351223984239189573","date":"2026-03-09T05:25:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202009589125242363228970661747887043105","date":"2026-03-02T17:15:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143504046082591010995149422334599420410","date":"2026-03-01T09:25:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320760022888399198417430319430785690619","date":"2026-02-28T13:47:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-28T10:24:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-02T07:40:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-02T07:39:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Spine Journal","date":"2025-12-30T12:57:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-spine-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"esjo","sideBox":"Learn more about [European Spine Journal](http://link.springer.com/journal/586)","snPcode":"586","submissionUrl":"https://submission.springernature.com/new-submission/586/3","title":"European Spine Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e8f00720-bf38-4249-b4d0-40bb73f1eeda","owner":[],"postedDate":"January 5th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-02T10:09:46+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-02T20:23:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-05 07:05:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8481580","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8481580","identity":"rs-8481580","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}