Impact of postoperative pain on patient satisfaction and quality of life after surgery for thoracic OPLL and OLF

Impact of postoperative pain on patient satisfaction and quality of life after surgery for thoracic OPLL and OLF | 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 Article Impact of postoperative pain on patient satisfaction and quality of life after surgery for thoracic OPLL and OLF Sadayuki Ito, Hiroaki Nakashima, Tsutomu Endo, Masayuki Miyagi, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7438838/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Surgical treatment for thoracic ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF) is effective but carries risks, and its impact on long-term quality of life (QOL) and satisfaction remains unclear. This study evaluated postoperative outcomes, including pain management, QOL, and treatment satisfaction, in patients undergoing thoracic ligament ossification surgery. This retrospective study included patients who underwent surgery for thoracic OPLL or OLF and were followed for over a year. Patient demographics, clinical and imaging findings, and postoperative outcomes were collected. Outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, Pain Detection Score, Numerical Rating Scale (NRS), and EuroQoL 5-Dimension 5-Level (EQ-5D-5L). Among 118 patients analyzed, postoperative improvements in JOA, EQ-5D-5L, and pain-related indices were observed. Satisfaction correlated strongly with pain satisfaction, EQ-5D-5L, and NRS scores. Receiver operating characteristic (ROC) analysis identified an NRS score of 3.5 as the cut-off for significant neuropathic pain. Patients with NRS ≥ 4 reported lower satisfaction and QOL, with more preoperative MRI signal changes. In conclusion, effective pain management, particularly addressing neuropathic pain, is crucial for improving QOL and satisfaction after thoracic ligament ossification surgery. Enhanced pain control and functional recovery are key to achieving better outcomes. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Neurology Biological sciences/Neuroscience Health sciences/Signs and symptoms Figures Figure 1 Figure 2 Figure 3 Introduction Ossification of the ligaments of the thoracic spine, particularly thoracic ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), is considered one of the most complex and difficult-to-treat cases of spinal disease. 1 These diseases cause nerve compression due to structural changes in the spine, which results in functional disability and pain. 2 The anatomical features of the thoracic spine and the complexity of the neural structures make the diagnosis and treatment of these diseases even more difficult. 3 4 5 Surgical treatment is one of the main treatment modalities for these diseases and is aimed at restoring neurological function and alleviating patient symptoms. 6 However, surgery carries risks, and a high rate of complications has been reported in thoracic OPLL surgery. 7 Studies on patients’ quality of life (QOL) and satisfaction after surgery are limited, although neurological recovery, as assessed using the Japanese Orthopaedic Association (JOA) score, can be achieved after surgery. The evaluation of patient-oriented outcomes has become an important assessment component for spinal surgery outcomes and allows for a comprehensive evaluation of treatment effectiveness. 8 9 Postoperative pain management and recovery of neurological function have a direct impact on patient QOL; therefore, a detailed analysis of these factors directly leads to improved treatment strategies. 10 Postoperative pain can be a factor that significantly reduces the QOL of patients. Residual pain limits the activities of daily living and causes psychological stress to the patients, resulting in decreased satisfaction with treatment. Therefore, postoperative pain management is an important factor in improving the QOL and outcomes of patients; 10 11 however, there are few studies regarding residual pain after surgery in thoracic OPLL and the relationship between postoperative pain, patient satisfaction, and QOL. The main objective of this multicenter study was to evaluate the outcomes of surgical treatment in patients with ligament ossification of the thoracic spine using patient-oriented outcomes. In addition, we aimed to identify the factors that contribute to treatment satisfaction and possible measures to improve patient satisfaction by conducting a detailed study of residual postoperative pain. Results Patient characteristics Table 1 summarizes the patients’ characteristics. This study included 118 patients, with 62 males and 56 females. The mean postoperative follow-up period was 5.1 ± 3.0 years, and the mean age at the time of surgery was 57.9 years (26–81 years). The most severe ossification was predominantly found in the lower thoracic region (T9–12; n = 37, 31.4%). The most common surgical method was posterior decompression and fixation (n = 73, 61.8%). Table 1 Patient demographics. Variable Value Age (years) 57.9 ± 12.7 Female 47.5% (56) BMI (kg/m 2 ) 29.5 ± 5.6 DM 35.6% (42) Duration from symptom onset to surgery (months) 13.2 ± 26.9 Imaging findings Ossification type (OPLL/OLF/OPLL + OLF) 26.3% (31)/23.7% (28)/50.0% (59) Ossification classification (segmental/continuous/mixed) 42.1% (50)/29.9% (35)/28.1% (33) Spinal canal occupancy (%) 50.5 ± 15.4 Intraspinal high-intensity area on MRI 67.8% (80) Clinical findings JOA score (preoperative) 5.8 ± 2.3 JOA score (postoperative) 8.3 ± 2.5 JOA recovery rate (%) 45.8 ± 34.0 Postoperative neurological symptom deterioration 11.9% (14) Surgical procedure Posterior decompression and fusion 61.8% (73) Posterior fusion 3.4% (4) Anterior decompression 1.7% (2) Posterior decompression 26.3% (31) Anterior decompression from posterior approach 5.1% (6) Anterior and posterior surgery 1.7% (2) Surgical level Upper (T1–4) 15.3% (18) Middle (T5–8) 16.1% (19) Lower (T9–12) 31.4% (37) Upper + middle 10.2% (12) Middle + lower 7.6% (9) Upper + lower 2.5% (3) Upper + middle + lower 16.9% (20) Data are shown as mean ± standard deviation or percentage (number) of patients, unless otherwise indicated. BMI, body mass index; DM, diabetes mellitus; OPLL, ossification of the posterior longitudinal ligament; OLF, ossification of the ligamentum flavum; MRI, magnetic resonance imaging; JOA, Japan Orthopaedic Association. Clinical outcomes The JOA score significantly improved from 5.8 preoperatively to 8.3 at the time of the survey (p < 0.001; Table 1 ). Postoperative neurological deterioration was observed in 11.9% of patients. Patient-reported outcomes QOL The EQ-5D-5L score significantly improved from 0.52 preoperatively to 0.71 at the time of the survey (p < 0.001; Table 2 ). Table 2 PROMs before surgery and at the time of the survey. Before surgery At the time of the survey p-value EQ-5D-5L 0.52 ± 0.24 0.71 ± 0.19 < 0.001 Low back pain VAS score (mm) 44.2 ± 34.3 34.4 ± 29.2 0.04 Lower-extremity pain VAS score (mm) 40.2 ± 34.5 29.7 ± 28.1 0.03 Lower-extremity numbness VAS score (mm) 53.5 ± 33.1 37.9 ± 31.3 < 0.001 NRS score 5.1 ± 3.6 3.3 ± 2.6 < 0.001 Pain Detection Score 12.4 ± 8.3 9.3 ± 6.4 < 0.001 Neuropathic pain (unlikely/unclear/probable) 60.2% (71)/21.2% (25)/18.6% (22) 76.3% (90)/13.5% (16)/10.2% (12) < 0.001 Data are shown as mean ± standard deviation or percentage (number) of patients, unless otherwise indicated. PROMs, patient-reported outcome measures; EQ-5D-5L, EuroQoL 5-Dimension 5-Level; VAS, Visual Analog Scale; NRS, Numerical Rating Scale. Pain The VAS score for low back pain significantly improved from 44.2 preoperatively to 34.4 at the time of the survey (p = 0.04). The VAS scores for lower-extremity pain and lower-extremity numbness also significantly improved from 40.2 to 29.7 (p = 0.03) and from 53.5 to 37.9 (p < 0.001), respectively. Neuropathic pain assessed using the Pain Detection Score The pain areas described in the Pain Detection Score were from the back to the lower extremities. The NRS score significantly improved from 5. 1 preoperatively to 3.3 at the time of the survey (p < 0.001). The total Pain Detection Score also significantly improved from 12.4 to 9.3 (p < 0.001). Furthermore, the classification of NeP significantly changed from non-NeP (60.2%), suspected NeP (21.2%), and NeP (18.6%) to non-NeP (76.3%), suspected NeP (13.5%), and NeP (10.2%) (p < 0.001). ROC analysis for the NeP components and NRS The ROC curve showed an AUC of 0.828 (p < 0.001). The optimal cut-off point for the NRS score was determined to be 3.5, indicating that scores ≥ 4 were likely to include NeP components (Fig. 1 ). The ROC curve was generated by plotting the sensitivity of neuropathic pain (Pain Detection Score ≥ 13) against 1-specificity at various threshold settings of the NRS score. The AUC was 0.828 (p < 0.001). The optimal cut-off point for the NRS score was 3.5. NRS, Numerical Rating Scale; ROC, receiver operating characteristic; AUC, area under the receiver operating characteristic curve. Satisfaction survey Treatment and pain satisfaction were rated at 73.8 and 61.6, respectively (Table 3 ). Treatment satisfaction was most strongly correlated with pain satisfaction (r = 0.737, p < 0.001). The treatment satisfaction was correlated with the postoperative JOA score (r = 0.325, p = 0.001) and JOA recovery rate (r = 0.382, p < 0.001), but the correlation coefficients were not very high (Fig. 2 ). Pain satisfaction was the most closely related to treatment satisfaction (r = 0.737, p < 0.001). In contrast, pain satisfaction was not correlated with the postoperative JOA score (r = 0.161, p = 0.105) or JOA recovery rate (r = 0.158, p = 0.107; Fig. 3 ). Table 3 Satisfaction survey for the patients (n = 118) at the time of the survey. Treatment satisfaction 73.8 ± 23.1 Pain satisfaction 61.9 ± 30.4 Data are shown as mean ± standard deviation. Treatment satisfaction was correlated with pain satisfaction (r = 0.737, p < 0.001), followed by EQ-5D-5L (r = 0.519, p < 0.001), NRS (r = 0.507, p < 0.001), Pain Detection Score (r = 0.479, p < 0.001), JOA recovery rate (r = 0.382, p < 0.001), postoperative JOA score (r = 0.325, p = 0.001), and JOA recovery rate. EQ-5D-5L, EuroQoL 5-Dimension 5-Level; NRS, Numerical Rating Scale; JOA, Japanese Orthopaedic Association. Pain satisfaction was associated with treatment satisfaction (r = 0.737, p < 0.001), followed by leg pain (r = 0.427, p < 0.001), NRS (r = 0.389, p < 0.001), and leg numbness (r = 0.368, p < 0.001) scores. Pain satisfaction was not correlated with postoperative JOA score (r = 0.161, p = 0.105) or JOA recovery rate (r = 0.158, p = 0.107). EQ-5D-5L, EuroQoL 5-Dimension 5-Level; NRS, Numerical Rating Scale; JOA, Japanese Orthopaedic Association. Medication use Of the patients, 46.6% used analgesics, with gabapentinoids being the most commonly used (22.9%), followed by non-steroidal anti-inflammatory drugs (22.0%), tramadol (13.6%), acetaminophen (5.1%), and duloxetine (2.5%). Other analgesics were administered to 19.5% of the patients. The mean number of analgesics used was 0.86 ± 1.15. No significant correlation was found between the use of medication and treatment or pain satisfaction (Treatment satisfaction, analgesic non-users: 74.0 ± 26.9 vs. analgesic users: 73.7 ± 18.8, p = 0.361; Pain Satisfaction, analgesic non-users: 59.0 ± 33.6 vs. analgesic users: 65.1 ± 26.5, p = 0.572). Impact of postoperative pain Comparing the groups with NRS scores above and below 4 (P group and N group, respectively), significant differences were observed in treatment satisfaction, pain satisfaction, postoperative QOL, and JOA score (Treatment satisfaction, P group: 81.1 ± 21.3 vs. N group: 63.0 ± 22.4, p < 0.001; Pain satisfaction, P group: 69.7 ± 30.1 vs. N group: 49.9 ± 28.1, p < 0.001; EQ-5D-5L, P group: 0.79 ± 0.16 vs. N group: 0.60 ± 0.17, p < 0.001; JOA score, P group: 8.7 ± 2.7 vs. N group: 7.5 ± 2.1, p < 0.001; Table 4 ). Table 4 Comparison of PROMs at the time of the survey between the N and P groups. At the time of the survey N group (n = 71) P group (n = 47) p-value EQ-5D-5L 0.79 ± 0.16 0.60 ± 0.17 < 0.001 JOA score 8.7 ± 2.7 7.5 ± 2.1 0.018 Treatment satisfaction 81.1 ± 21.3 63.0 ± 22.4 < 0.001 Pain satisfaction 69.7 ± 30.1 49.9 ± 28.1 < 0.001 Data are shown as mean ± standard deviation. The N group includes patients with NRS scores below 4 at the time of the survey, whereas the P group includes patients with NRS scores above 4 at the time of the survey. PROMs, patient-reported outcome measures; EQ-5D-5L, EuroQoL 5-Dimension 5-Level; JOA, Japan Orthopaedic Association. Persistent postoperative pain was associated with poor treatment outcomes. The preoperative factors related to persistent postoperative pain included the presence of signal intensity changes on MRI (P group: 80.9 vs. N group: 59.2, p = 0.020; Table 5 ). There were no significant differences in age, sex, BMI, or duration from symptom onset to surgery between the P and N groups. Table 5 Comparison of preoperative parameters between the N and P groups. Preoperative N group (n = 71) P group (n = 47) p-value Age (years) 58.5 ± 12.7 55.1 ± 12.7 0.165 Female 42.3% (30) 55.3% (26) 0.171 BMI (kg/m 2 ) 29.4 ± 5.5 30.2 ± 6 0.557 DM 38.0% (27) 31.9% (15) 0.548 Duration from symptom onset to surgery 12 ± 28.6 10.2 ± 18.1 0.716 Ossification type (OPLL/OLF/OPLL + OLF) 22.5% (16)/25.4% (18)/52.1% (37) 31.9% (15)/21.3% (10)/46.8% (22) 0.520 Ossification classification (segmental/continuous/mixed) 36.6% (26)/32.4% (23)/31.0% (22) 51.1% (24)/25.5% (12)/23.4% (11) 0.460 Spinal canal occupancy (%) 51.5 ± 15 50.1 ± 16.5 0.664 Intraspinal high-intensity area on MRI 59.2% (42) 80.9% (38) 0.020 JOA score 6.09 ± 2.24 5.25 ± 2.07 0.062 EQ-5D-5L 0.54 ± 0.26 0.49 ± 0.21 0.253 Low back pain VAS score (mm) 35.2 ± 33.5 56.8 ± 32.9 0.003 Lower-extremity pain VAS score (mm) 31.6 ± 33.8 51.7 ± 33 0.003 Lower-extremity numbness VAS score (mm) 46.2 ± 33.8 61.2 ± 30.8 0.028 NRS 4.3 ± 3.8 6.4 ± 3.0 < 0.001 Pain Detection Score 10.0 ± 6.6 15.8 ± 9.0 < 0.001 Data are shown as mean ± standard deviation or percentage (number) of patients, unless otherwise indicated. The N group includes patients with NRS scores below 4 at the time of the survey, whereas the P group includes patients with NRS scores above 4 at the time of the survey. BMI, body mass index; DM, diabetes mellitus; OPLL, ossification of posterior longitudinal ligamentum; OLF, ossification of ligamentum flavum; MRI, magnetic resonance imaging; JOA, Japan Orthopaedic Association; EQ-5D-5L, EuroQoL 5-Dimension 5-Level; VAS, Visual Analog Scale; NRS, Numerical Rating Scale. Illustrative cases Case 1: P group, intraspinal high-intensity area on MRI The patient was an 84-year-old male with cervical and thoracic OPLL + OLF and progressive myelopathy (Supplemental Figs. 1a and 2a). The most stenotic level was T8/9, and the spinal canal occupancy was 46.0% (Supplemental Figs. 1b and 2b). His BMI was 29.6 kg/m 2 and the duration from symptom onset to surgery was 18 months. He underwent C7–T1 laminoplasty, T2–L1 posterior decompression, and fixation with instrumentation (Supplemental Figs. 1c–d and 2c–d). An intraspinal high-intensity area was observed on the MRI before and after the surgery (Supplemental Fig. 1a–d). From before surgery to 8 years after surgery, the NRS score, Pain Detection Score, leg pain VAS score, leg numbness VAS score, EQ-5D-5L score, and JOA score shifted from 8 to 8, from 15 to 16, from 10 to 80, from 15 to 80, from 0.96 to 0.31, and from 6 to 6, respectively. At 10 years postoperatively, acetaminophen and gabapentinoids were used, the JOA recovery rate was 0%, treatment satisfaction was 45, and pain satisfaction was 70. Case 2: N group, no intraspinal high-intensity area on MRI The patient was a 61-year-old female with cervical and thoracic OPLL + OLF and progressive myelopathy (Supplemental Figs. 3a and 4a). The most stenotic level was T4/5, and the spinal canal occupancy was 77.7% (Supplemental Figs. 3b and 4b). Her BMI was 29.1 kg/m 2 and the duration from symptom onset to surgery was 12 months. She underwent C6–T1 laminoplasty, T2–9 posterior decompression, and fixation with instrumentation (Supplemental Figs. 3c–d and 4c–d). There were no high-intensity intraspinal areas on MRI before or after surgery (Supplemental Fig. 3a–d). From before surgery to 10 years after surgery, the NRS score, Pain Detection Score, leg pain VAS score, leg numbness VAS score, EQ-5D-5L score, and JOA score shifted from 3 to 0, from 5 to 6, from 15 to 0, from 90 to 15, from 0.12 to 0.84, and from 3 to 5, respectively. At 10 years postoperatively, no analgesics were used, the JOA recovery rate was 25%, treatment satisfaction was 100, and pain satisfaction was 100. Discussion This study evaluated the postoperative treatment outcomes of patients who underwent surgery for thoracic OPLL and OLF, with a focus on patient satisfaction, pain satisfaction, JOA score, and various pain-related indices. Although there have been reports on the relationship between pain and QOL in cervical spine diseases, to the best of our knowledge, this is the first study to investigate this relationship in thoracic ligament ossification. 10 12 Patient satisfaction was most associated with pain management. It was observed that in cases where postoperative pain persisted, patient satisfaction and QOL were lower; thus, the importance of appropriate assessment and management of NeP was highlighted. In cases where the postoperative NRS score was ≥ 4, there were elements of NeP that indicated poor treatment outcomes. Furthermore, preoperative signal intensity changes on MRI were associated with residual postoperative pain. These findings suggest that pain management plays an important role in the QOL and patient satisfaction after surgery for thoracic ligament ossification, with a worse prognosis in patients with a NeP component and more residual pain in patients with MRI intensity changes. Outcomes collected directly from patients without interpretation of healthcare providers are known as patient-reported outcomes. 13 Although medical technology can measure the physical, physiological, and biochemical data of patients, these data cannot adequately represent patient suffering. 14 Pain is a multifaceted and subjective outcome that is difficult to measure from the perspective of medical technology or healthcare providers. 15 Therefore, patient-reported outcomes can provide more accurate information about the impact of pain in individuals. The results of this study show that patient satisfaction is mostly related to pain, implying that pain management significantly influences the overall satisfaction of patients with their treatment. Previous studies have reported that among patients with cervical OPLL, those with lower satisfaction experienced significantly more pain. 16 Most patients with chronic pain and spinal-related issues are affected in their physical activities. 17 These findings are congruent to the patients in this study with thoracic OPLL. Chronic NeP has a greater impact on the QOL, psychological distress, and social functioning of patients, 18 and inadequate management can significantly affect patient satisfaction. It was found that the intensity of pain was higher in participants with NeP than in patients without NeP. 19 In this study, a higher proportion of NeP was observed in patients with an NRS score of ≥ 4. The prevalence of NeP in Asia has been reported to be 3.2%. 18 The prevalence of NeP in patients with thoracic OPLL was 39.8% preoperatively and 23.7% postoperatively, which was significantly higher than that of previous studies. Among patients with chronic pain, 20% were diagnosed with NeP, 20 and among patients with spinal diseases, 53.3% were reported to have NeP, 21 which indicates the high proportion of NeP in spinal diseases. In pain management, the use of specialized treatments for the nervous system, in addition to standard analgesics, has been shown to be effective especially for NeP. 17 In this study, gabapentinoid use was more common in patients with NeP. Psychological support, physical therapy, and lifestyle modifications are also necessary for a multifaceted approach to improving pain satisfaction. 22 The primary objective of chronic pain treatment is to eliminate pain, restore normal function, reduce comorbid conditions, such as depression, anxiety disorders, and sleep disorders, and improve the QOL of patients. Healthcare providers must carefully consider the pain experienced by the patients, and recognize the specific type of pain in order to provide appropriate management directed at the underlying cause. We also examined the types of medications used postoperatively, which showed that the use of medication did not directly affect patient satisfaction, suggesting that the choice and use of appropriate medication, and not the use of the medication itself, is important. Controlling pain to an NRS score of < 4 may contribute to improving patient satisfaction. The only preoperative factor related to residual postoperative pain was the change in MRI signal intensity. Changes in the MRI signal intensity in spinal diseases have been associated with chronic NeP, which may reflect damage to or degeneration of the spinal cord and nerve tissue that may affect the course of postoperative residual pain. 23 24 25 High signal intensity changes on MRI have been reported to be associated with severe spinal cord injury 25 and are related to clinical outcomes in spinal diseases. 26 Intramedullary signal intensity changes on MRI were associated with NeP. 17 Similar associations have been observed in patients with thoracic ligament ossification. Subtle findings, such as changes in signal intensity on MRI, are important indicators for predicting the risk of postoperative pain and for formulating appropriate treatment plans. This study has several limitations. First, the sample size was small, which restricts the generalizability of the results. However, the study was conducted at multiple facilities, and the number of cases of thoracic ligament ossification was relatively large. The study was limited to surgical cases and no comparison was made with conservative treatment, which would have emphasized the significance of surgical treatment. The assessment of pain relied on quantitative scales, such as the NRS score and Pain Detection Score, but these scales may not fully capture the complexity and multifaceted nature of pain. Long-term follow-up studies are needed to obtain detailed information on treatment effects and complication rates, which are crucial for developing strategies for progressive diseases, such as OPLL. In conclusion, this study elucidated factors related to patient satisfaction after surgical treatment in patients with thoracic OPLL and OLF. Pain management and assessment of NeP significantly influenced patient satisfaction. These findings have important implications in the development of future treatment approaches. Methods Study participants The present study included patients who underwent surgery for thoracic OPLL or OLF at participating facilities. Patients were surveyed at more than 1 year postoperatively from July 2022 to July 2023. This study was approved by the Institutional Review Board of the Nagoya University Graduate School of Medicine (2005-0354-7). All study participants provided informed consent. All methods were performed in accordance with the principle of the Declaration of Helsinki and Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan. Clinical and imaging data Data collected from the medical records included age, sex, body mass index (BMI), preexisting conditions, such as diabetes mellitus (DM), duration of illness before surgery, preoperative JOA score, surgical procedure, surgical level, and preoperative imaging findings. Imaging findings included ossification sites (OPLL, OLF, and OPLL + OLF), ossification types (segmental, continuous, and mixed), spinal canal occupancy rate (calculated from computed tomography scans, which measured the narrowest axial spinal canal anteroposterior diameter and the anteroposterior diameter of ossification), and the presence or absence of intramedullary signal changes on magnetic resonance imaging (MRI). Postoperative neurological deterioration was assessed by worsening muscle manual testing by one or more compared to the preoperative status. Questionnaire survey The survey included questions on the type of analgesics used at the time of the survey, treatment satisfaction (0–100), pain satisfaction (0–100), JOA score, Pain Detection Score, Numerical Rating Scale (NRS) score (0–10), back pain Visual Analog Scale (VAS) score (0–100 mm), leg pain VAS score (0–100 mm), leg numbness VAS score (0–100 mm), and EuroQoL 5-Dimension 5-Level score (EQ-5D-5L). The preoperative status was also surveyed for the Pain Detection Score, NRS score, back pain VAS score, leg pain VAS score, leg numbness VAS score, and EQ-5D-5L score. The JOA score was evaluated (maximum 11 points), and the postoperative JOA recovery rate was calculated as follows: (postoperative - preoperative JOA score) × 100 / (maximum JOA score - preoperative JOA score). The Japanese version of the Pain Detection Score was used to assess the presence of neuropathic pain, 27 which consisted of nine self-reported questionnaire items, including seven weighted sensory descriptor items and two items related to the spatial and temporal characteristics of the pain pattern of an individual. Participants were categorized into three groups based on their scores: <13 indicating non-neuropathic pain (NeP), ≥ 13 but < 19 indicating suspected NeP, and ≥ 19 indicating NeP. Patients with scores of ≥ 13 were classified into the NeP group, while those with scores < 13 were placed in the non-NeP group, following the methodology of previous studies. 28 20 29 Statistical analyses Statistical analyses were performed using SPSS for Windows version 28 (IBM Corp.). The Mann–Whitney U test and chi-square test were used, and statistical significance was set at p < 0.05. Data were presented as mean ± standard deviation. The receiver operating characteristic (ROC) analysis was conducted to determine the cut-off NRS score for determining the presence of NeP. The NRS scores served as the test variable, whereas the binary classification was determined by the presence or absence of NeP, as defined by the Pain Detection Score. The sensitivity and specificity of each possible cut-off point for the NRS score were calculated. The ROC curve was generated by plotting the sensitivity against the 1-specificity at various threshold settings of the NRS score. The area under the ROC curve (AUC) was calculated to measure the accuracy of the NRS as a test for NeP. The optimal cut-off point for the NRS score was determined as the point on the curve closest to the top-left corner, which represented the best balance of sensitivity and specificity. Data availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Declarations Disclaimer The manuscript submitted does not contain information about medical devices/drugs. Competing interests This work was supported by the Japan Agency for Medical Research and Development (grant number JP21ek010954) and Health and Labor Science Research Grants (grant number 40). Ethics approval The study was approved by the Institutional Review Board of the Nagoya University Graduate School of Medicine (2005-0354-7). Informed consent was obtained from each patient prior to inclusion in the study. Funding This work was supported by the Japan Agency for Medical Research and Development (grant number JP21ek010954) and Health and Labor Science Research Grants (grant number 40). Author Contribution S.It.: Conception and design, drafting of the manuscript, statistical analysis. H.Nakas.: Conception and design, critical revision. T.E.: Acquisition and data, review submitted manuscript. M.M.: Acquisition and data, review submitted manuscript. G.I.: Acquisition and data, review submitted manuscript. M.K.: Acquisition and data, review submitted manuscript. S.K.: Acquisition and data, review submitted manuscript. S.T.: Acquisition and data, review submitted manuscript. T.H.: Acquisition and data, review submitted manuscript. K.M.: Acquisition and data, review submitted manuscript. H.Nakaj.: Acquisition and data, review submitted manuscript. K.K.: Acquisition and data, review submitted manuscript. S.D.: Acquisition and data, review submitted manuscript. M.T.: Acquisition and data, review submitted manuscript. T.Y.: Acquisition and data, review submitted manuscript. M.Y.: Supervision. S.Im.: Supervision. Acknowledgement This work was supported by the Japan Agency for Medical Research and Development (grant number JP21ek010954) and Health and Labor Science Research Grants (grant number 40). Data Availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. References Barnett, G. H., Hardy, R. W. Jr., Little, J. R., Bay, J. W. & Sypert, G. W. Thoracic spinal canal stenosis. J. Neurosurg. 66 , 338–344. 10.3171/jns.1987.66.3.0338 (1987). Miyasaka, K. et al. Myelopathy due to ossification or calcification of the ligamentum flavum: radiologic and histologic evaluations. AJNR Am. J. Neuroradiol. 4 , 629–632 (1983). Dommisse, G. F. The blood supply of the spinal cord. A critical vascular zone in spinal surgery. J. Bone Joint Surg. Br. 56 , 225–235 (1974). Aizawa, T. et al. Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. J. Neurosurg. Spine . 7 , 13–20. 10.3171/spi-07/07/013 (2007). Yamazaki, M. et al. Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament: a case report. Spine (Phila Pa ) 30, E343-346, ) 30, E343-346, (1976). 10.1097/01.brs.0000166504.31627.06 (2005). Hirabayashi, S., Kitagawa, T., Yamamoto, I., Yamada, K. & Kawano, H. Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach. Spine Surg. Relat. Res. 2 , 169–176. 10.22603/ssrr.2017-0044 (2018). Imagama, S. et al. Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study. Spine (Phila Pa ) 43, E1389-E1397, ) 43, E1389-E1397, (1976). https://doi.org/10.1097/BRS.0000000000002703 (2018). Finkelstein, J. A. & Schwartz, C. E. Patient-reported outcomes in spine surgery: past, current, and future directions. J. Neurosurg. Spine . 31 , 155–164. 10.3171/2019.1.Spine18770 (2019). Nakashima, H. et al. Comparison of Outcomes of Surgical Treatment for Ossification of the Posterior Longitudinal Ligament Versus Other Forms of Degenerative Cervical Myelopathy: Results from the Prospective, Multicenter AOSpine CSM-International Study of 479 Patients. J. Bone Joint Surg. Am. 98 , 370–378. 10.2106/jbjs.O.00397 (2016). Nagoshi, N. et al. Clinical Indicators of Surgical Outcomes After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study. Spine (Phila Pa. 1976) . 47 , 1077–1083. 10.1097/brs.0000000000004359 (2022). Benjamin, D. et al. Recovery priorities in degenerative cervical myelopathy: a cross-sectional survey of an international, online community of patients. BMJ Open. 9 , e031486. 10.1136/bmjopen-2019-031486 (2019). Miyagi, M. et al. Residual Neuropathic Pain in Postoperative Patients With Cervical Ossification of Posterior Longitudinal Ligament. Clin. Spine Surg. 36 , E277–e282. 10.1097/bsd.0000000000001449 (2023). Deshpande, P. R., Rajan, S. & Sudeepthi, B. L. Abdul Nazir, C. P. Patient-reported outcomes: A new era in clinical research. Perspect. Clin. Res. 2 , 137–144. 10.4103/2229-3485.86879 (2011). McKenna, S. P. Measuring patient-reported outcomes: moving beyond misplaced common sense to hard science. BMC Med. 9 10.1186/1741-7015-9-86 (2011). de Moraes Vieira, E. B., Garcia, J. B., da Silva, A. A., Araújo, M., Jansen, R. C. & R. L. & Prevalence, characteristics, and factors associated with chronic pain with and without neuropathic characteristics in São Luís, Brazil. J. Pain Symptom Manage. 44 , 239–251. 10.1016/j.jpainsymman.2011.08.014 (2012). Fujimori, T. et al. Patient satisfaction with surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament. J. Neurosurg. Spine . 14 , 726–733. 10.3171/2011.1.Spine10649 (2011). Nakajima, H. et al. Multicenter cross-sectional study of the clinical features and types of treatment of spinal cord-related pain syndrome. J. Orthop. Sci. 24 , 798–804. 10.1016/j.jos.2019.01.012 (2019). Inoue, S., Taguchi, T., Yamashita, T., Nakamura, M. & Ushida, T. The prevalence and impact of chronic neuropathic pain on daily and social life: A nationwide study in a Japanese population. Eur. J. Pain . 21 , 727–737. 10.1002/ejp.977 (2017). Luo, N., Johnson, J. A., Shaw, J. W., Feeny, D. & Coons, S. J. Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index. Med. Care . 43 , 1078–1086. 10.1097/01.mlr.0000182493.57090.c1 (2005). Nakamura, M. et al. Investigation of chronic musculoskeletal pain (third report): with special reference to the importance of neuropathic pain and psychogenic pain. J. Orthop. Sci. 19 , 667–675. 10.1007/s00776-014-0567-6 (2014). Yamashita, T., Takahashi, K., Yonenobu, K. & Kikuchi, S. Prevalence of neuropathic pain in cases with chronic pain related to spinal disorders. J. Orthop. Sci. 19 , 15–21. 10.1007/s00776-013-0496-9 (2014). Poliakov, I. & Toth, C. The impact of pain in patients with polyneuropathy. Eur. J. Pain . 15 , 1015–1022. 10.1016/j.ejpain.2011.04.013 (2011). Mizuno, J., Nakagawa, H., Inoue, T. & Hashizume, Y. Clinicopathological study of snake-eye appearance in compressive myelopathy of the cervical spinal cord. J. Neurosurg. 99 , 162–168. 10.3171/spi.2003.99.2.0162 (2003). Al-Mefty, O., Harkey, L. H., Middleton, T. H., Smith, R. R. & Fox, J. L. Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging. J. Neurosurg. 68 , 217–222. 10.3171/jns.1988.68.2.0217 (1988). Ohshio, I., Hatayama, A., Kaneda, K., Takahara, M. & Nagashima, K. Correlation between histopathologic features and magnetic resonance images of spinal cord lesions. Spine (Phila Pa. 1976) . 18 , 1140–1149. 10.1097/00007632-199307000-00005 (1993). Yukawa, Y., Kato, F., Yoshihara, H., Yanase, M. & Ito, K. MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine (Phila Pa. 1976) . 32 , 1675–1678. 10.1097/BRS.0b013e318074d62e (2007). discussion 1679. Matsubayashi, Y. et al. Validity and reliability of the Japanese version of the painDETECT questionnaire: a multicenter observational study. PLoS One . 8 , e68013. 10.1371/journal.pone.0068013 (2013). Hochman, J. R., Davis, A. M., Elkayam, J., Gagliese, L. & Hawker, G. A. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthr. Cartil. 21 , 1236–1242. 10.1016/j.joca.2013.06.023 (2013). Koop, S. M., ten Klooster, P. M., Vonkeman, H. E., Steunebrink, L. M. & van de Laar, M. A. Neuropathic-like pain features and cross-sectional associations in rheumatoid arthritis. Arthritis Res. Ther. 17 , 237. 10.1186/s13075-015-0761-8 (2015). Additional Declarations No competing interests reported. Supplementary Files SupplementalFigures.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 14 Jan, 2026 Reviewers agreed at journal 22 Dec, 2025 Reviewers invited by journal 22 Dec, 2025 Editor invited by journal 28 Aug, 2025 Editor assigned by journal 28 Aug, 2025 Submission checks completed at journal 26 Aug, 2025 First submitted to journal 23 Aug, 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. 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01:19:32","extension":"xml","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114270,"visible":true,"origin":"","legend":"","description":"","filename":"7dda32cf9cba46f0ad7b64951d167ad71structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7438838/v1/143af1048719620aad1f9b66.xml"},{"id":99193235,"identity":"c1359428-6921-47f7-9a44-0a3e7350dc2c","added_by":"auto","created_at":"2025-12-30 01:19:32","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128694,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7438838/v1/f976385d9a73d25a7dafd9de.html"},{"id":99193224,"identity":"0223bbdc-46ea-4dfe-8264-dc69da98fdea","added_by":"auto","created_at":"2025-12-30 01:19:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33252,"visible":true,"origin":"","legend":"\u003cp\u003eThe cut-off value of the NRS for patients with neuropathic pain.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7438838/v1/bc0d2d763fcab5615fe5d827.png"},{"id":99193225,"identity":"bb85934b-e714-4bc9-83f0-fccf134782ca","added_by":"auto","created_at":"2025-12-30 01:19:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36725,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between treatment satisfaction and the pain satisfaction, EQ-5D-5L, NRS, Pain Detection Score, JOA recovery rate, and postoperative JOA score.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7438838/v1/310169b82194198abc3b3393.png"},{"id":99316767,"identity":"ab13e9c6-c124-448f-ba4a-047b63078802","added_by":"auto","created_at":"2025-12-31 16:29:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":34941,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between pain satisfaction and the treatment satisfaction, EQ-5D-5L, NRS, Pain Detection Score, JOA recovery rate, and postoperative JOA score.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7438838/v1/5acb2bc1a089db64ac4efcf9.png"},{"id":99323726,"identity":"4fd3d92f-d51b-420b-bc59-eb2e7349a92d","added_by":"auto","created_at":"2025-12-31 16:46:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1039826,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7438838/v1/27e09b8f-9013-4326-aba9-4cfc1267e871.pdf"},{"id":99193222,"identity":"29114f82-c9cc-4ddc-8c74-0ca9cd25d873","added_by":"auto","created_at":"2025-12-30 01:19:31","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":955981,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFigures.docx","url":"https://assets-eu.researchsquare.com/files/rs-7438838/v1/9784707cad3eebf89a301517.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of postoperative pain on patient satisfaction and quality of life after surgery for thoracic OPLL and OLF","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOssification of the ligaments of the thoracic spine, particularly thoracic ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), is considered one of the most complex and difficult-to-treat cases of spinal disease.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e These diseases cause nerve compression due to structural changes in the spine, which results in functional disability and pain.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The anatomical features of the thoracic spine and the complexity of the neural structures make the diagnosis and treatment of these diseases even more difficult.\u003csup\u003e3 4 5\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSurgical treatment is one of the main treatment modalities for these diseases and is aimed at restoring neurological function and alleviating patient symptoms.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e However, surgery carries risks, and a high rate of complications has been reported in thoracic OPLL surgery.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Studies on patients\u0026rsquo; quality of life (QOL) and satisfaction after surgery are limited, although neurological recovery, as assessed using the Japanese Orthopaedic Association (JOA) score, can be achieved after surgery.\u003c/p\u003e \u003cp\u003eThe evaluation of patient-oriented outcomes has become an important assessment component for spinal surgery outcomes and allows for a comprehensive evaluation of treatment effectiveness.\u003csup\u003e8 9\u003c/sup\u003e Postoperative pain management and recovery of neurological function have a direct impact on patient QOL; therefore, a detailed analysis of these factors directly leads to improved treatment strategies.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePostoperative pain can be a factor that significantly reduces the QOL of patients. Residual pain limits the activities of daily living and causes psychological stress to the patients, resulting in decreased satisfaction with treatment. Therefore, postoperative pain management is an important factor in improving the QOL and outcomes of patients;\u003csup\u003e10 11\u003c/sup\u003e however, there are few studies regarding residual pain after surgery in thoracic OPLL and the relationship between postoperative pain, patient satisfaction, and QOL.\u003c/p\u003e \u003cp\u003eThe main objective of this multicenter study was to evaluate the outcomes of surgical treatment in patients with ligament ossification of the thoracic spine using patient-oriented outcomes. In addition, we aimed to identify the factors that contribute to treatment satisfaction and possible measures to improve patient satisfaction by conducting a detailed study of residual postoperative pain.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the patients\u0026rsquo; characteristics. This study included 118 patients, with 62 males and 56 females. The mean postoperative follow-up period was 5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 years, and the mean age at the time of surgery was 57.9 years (26\u0026ndash;81 years). The most severe ossification was predominantly found in the lower thoracic region (T9\u0026ndash;12; n\u0026thinsp;=\u0026thinsp;37, 31.4%). The most common surgical method was posterior decompression and fixation (n\u0026thinsp;=\u0026thinsp;73, 61.8%).\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\u003ePatient demographics.\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\u003eVariable\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\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\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\u003e47.5% (56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.6% (42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration from symptom onset to surgery (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;26.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImaging findings\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\u003eOssification type (OPLL/OLF/OPLL\u0026thinsp;+\u0026thinsp;OLF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.3% (31)/23.7% (28)/50.0% (59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOssification classification (segmental/continuous/mixed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.1% (50)/29.9% (35)/28.1% (33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal canal occupancy (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraspinal high-intensity area on MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.8% (80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical findings\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\u003eJOA score (preoperative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJOA score (postoperative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJOA recovery rate (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.8\u0026thinsp;\u0026plusmn;\u0026thinsp;34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative neurological symptom deterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.9% (14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical procedure\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\u003ePosterior decompression and fusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.8% (73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior fusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.4% (4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior decompression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7% (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior decompression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.3% (31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior decompression from posterior approach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1% (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior and posterior surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7% (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical level\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\u003eUpper (T1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.3% (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle (T5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.1% (19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower (T9\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.4% (37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper\u0026thinsp;+\u0026thinsp;middle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.2% (12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u0026thinsp;+\u0026thinsp;lower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.6% (9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper\u0026thinsp;+\u0026thinsp;lower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5% (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper\u0026thinsp;+\u0026thinsp;middle\u0026thinsp;+\u0026thinsp;lower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.9% (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eData are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or percentage (number) of patients, unless otherwise indicated.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBMI, body mass index; DM, diabetes mellitus; OPLL, ossification of the posterior longitudinal ligament; OLF, ossification of the ligamentum flavum; MRI, magnetic resonance imaging; JOA, Japan Orthopaedic Association.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical outcomes\u003c/h3\u003e\n\u003cp\u003eThe JOA score significantly improved from 5.8 preoperatively to 8.3 at the time of the survey (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Postoperative neurological deterioration was observed in 11.9% of patients.\u003c/p\u003e\n\u003ch3\u003ePatient-reported outcomes\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eQOL\u003c/h2\u003e \u003cp\u003eThe EQ-5D-5L score significantly improved from 0.52 preoperatively to 0.71 at the time of the survey (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003ePROMs before surgery and at the time of the survey.\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\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAt the time of the survey\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\u003eEQ-5D-5L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow back pain VAS score (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.2\u0026thinsp;\u0026plusmn;\u0026thinsp;34.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.4\u0026thinsp;\u0026plusmn;\u0026thinsp;29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower-extremity pain VAS score (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.2\u0026thinsp;\u0026plusmn;\u0026thinsp;34.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;28.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower-extremity numbness VAS score (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.5\u0026thinsp;\u0026plusmn;\u0026thinsp;33.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.9\u0026thinsp;\u0026plusmn;\u0026thinsp;31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Detection Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuropathic pain (unlikely/unclear/probable)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.2% (71)/21.2% (25)/18.6% (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.3% (90)/13.5% (16)/10.2% (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or percentage (number) of patients, unless otherwise indicated.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePROMs, patient-reported outcome measures; EQ-5D-5L, EuroQoL 5-Dimension 5-Level; VAS, Visual Analog Scale; NRS, Numerical Rating Scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePain\u003c/h3\u003e\n\u003cp\u003eThe VAS score for low back pain significantly improved from 44.2 preoperatively to 34.4 at the time of the survey (p\u0026thinsp;=\u0026thinsp;0.04). The VAS scores for lower-extremity pain and lower-extremity numbness also significantly improved from 40.2 to 29.7 (p\u0026thinsp;=\u0026thinsp;0.03) and from 53.5 to 37.9 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eNeuropathic pain assessed using the Pain Detection Score\u003c/h2\u003e \u003cp\u003eThe pain areas described in the Pain Detection Score were from the back to the lower extremities. The NRS score significantly improved from 5. 1 preoperatively to 3.3 at the time of the survey (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The total Pain Detection Score also significantly improved from 12.4 to 9.3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the classification of NeP significantly changed from non-NeP (60.2%), suspected NeP (21.2%), and NeP (18.6%) to non-NeP (76.3%), suspected NeP (13.5%), and NeP (10.2%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eROC analysis for the NeP components and NRS\u003c/h3\u003e\n\u003cp\u003eThe ROC curve showed an AUC of 0.828 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The optimal cut-off point for the NRS score was determined to be 3.5, indicating that scores\u0026thinsp;\u0026ge;\u0026thinsp;4 were likely to include NeP components (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe ROC curve was generated by plotting the sensitivity of neuropathic pain (Pain Detection Score\u0026thinsp;\u0026ge;\u0026thinsp;13) against 1-specificity at various threshold settings of the NRS score. The AUC was 0.828 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The optimal cut-off point for the NRS score was 3.5. NRS, Numerical Rating Scale; ROC, receiver operating characteristic; AUC, area under the receiver operating characteristic curve.\u003c/p\u003e\n\u003ch3\u003eSatisfaction survey\u003c/h3\u003e\n\u003cp\u003eTreatment and pain satisfaction were rated at 73.8 and 61.6, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Treatment satisfaction was most strongly correlated with pain satisfaction (r\u0026thinsp;=\u0026thinsp;0.737, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The treatment satisfaction was correlated with the postoperative JOA score (r\u0026thinsp;=\u0026thinsp;0.325, p\u0026thinsp;=\u0026thinsp;0.001) and JOA recovery rate (r\u0026thinsp;=\u0026thinsp;0.382, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but the correlation coefficients were not very high (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Pain satisfaction was the most closely related to treatment satisfaction (r\u0026thinsp;=\u0026thinsp;0.737, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, pain satisfaction was not correlated with the postoperative JOA score (r\u0026thinsp;=\u0026thinsp;0.161, p\u0026thinsp;=\u0026thinsp;0.105) or JOA recovery rate (r\u0026thinsp;=\u0026thinsp;0.158, p\u0026thinsp;=\u0026thinsp;0.107; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\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\u003eSatisfaction survey for the patients (n\u0026thinsp;=\u0026thinsp;118) at the time of the survey.\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\u003eTreatment satisfaction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.1\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.9\u0026thinsp;\u0026plusmn;\u0026thinsp;30.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eData are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTreatment satisfaction was correlated with pain satisfaction (r\u0026thinsp;=\u0026thinsp;0.737, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), followed by EQ-5D-5L (r\u0026thinsp;=\u0026thinsp;0.519, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), NRS (r\u0026thinsp;=\u0026thinsp;0.507, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Pain Detection Score (r\u0026thinsp;=\u0026thinsp;0.479, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), JOA recovery rate (r\u0026thinsp;=\u0026thinsp;0.382, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), postoperative JOA score (r\u0026thinsp;=\u0026thinsp;0.325, p\u0026thinsp;=\u0026thinsp;0.001), and JOA recovery rate. EQ-5D-5L, EuroQoL 5-Dimension 5-Level; NRS, Numerical Rating Scale; JOA, Japanese Orthopaedic Association.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePain satisfaction was associated with treatment satisfaction (r\u0026thinsp;=\u0026thinsp;0.737, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), followed by leg pain (r\u0026thinsp;=\u0026thinsp;0.427, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), NRS (r\u0026thinsp;=\u0026thinsp;0.389, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and leg numbness (r\u0026thinsp;=\u0026thinsp;0.368, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) scores. Pain satisfaction was not correlated with postoperative JOA score (r\u0026thinsp;=\u0026thinsp;0.161, p\u0026thinsp;=\u0026thinsp;0.105) or JOA recovery rate (r\u0026thinsp;=\u0026thinsp;0.158, p\u0026thinsp;=\u0026thinsp;0.107). EQ-5D-5L, EuroQoL 5-Dimension 5-Level; NRS, Numerical Rating Scale; JOA, Japanese Orthopaedic Association.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMedication use\u003c/h2\u003e \u003cp\u003eOf the patients, 46.6% used analgesics, with gabapentinoids being the most commonly used (22.9%), followed by non-steroidal anti-inflammatory drugs (22.0%), tramadol (13.6%), acetaminophen (5.1%), and duloxetine (2.5%). Other analgesics were administered to 19.5% of the patients. The mean number of analgesics used was 0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15.\u003c/p\u003e \u003cp\u003eNo significant correlation was found between the use of medication and treatment or pain satisfaction (Treatment satisfaction, analgesic non-users: 74.0\u0026thinsp;\u0026plusmn;\u0026thinsp;26.9 vs. analgesic users: 73.7\u0026thinsp;\u0026plusmn;\u0026thinsp;18.8, p\u0026thinsp;=\u0026thinsp;0.361; Pain Satisfaction, analgesic non-users: 59.0\u0026thinsp;\u0026plusmn;\u0026thinsp;33.6 vs. analgesic users: 65.1\u0026thinsp;\u0026plusmn;\u0026thinsp;26.5, p\u0026thinsp;=\u0026thinsp;0.572).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eImpact of postoperative pain\u003c/h2\u003e \u003cp\u003eComparing the groups with NRS scores above and below 4 (P group and N group, respectively), significant differences were observed in treatment satisfaction, pain satisfaction, postoperative QOL, and JOA score (Treatment satisfaction, P group: 81.1\u0026thinsp;\u0026plusmn;\u0026thinsp;21.3 vs. N group: 63.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Pain satisfaction, P group: 69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.1 vs. N group: 49.9\u0026thinsp;\u0026plusmn;\u0026thinsp;28.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; EQ-5D-5L, P group: 0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16 vs. N group: 0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; JOA score, P group: 8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 vs. N group: 7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\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\u003eComparison of PROMs at the time of the survey between the N and P groups.\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=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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\u003eAt the time of the survey\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP group (n\u0026thinsp;=\u0026thinsp;47)\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\u003eEQ-5D-5L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJOA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e81.1\u0026thinsp;\u0026plusmn;\u0026thinsp;21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e63.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e49.9\u0026thinsp;\u0026plusmn;\u0026thinsp;28.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The N group includes patients with NRS scores below 4 at the time of the survey, whereas the P group includes patients with NRS scores above 4 at the time of the survey.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePROMs, patient-reported outcome measures; EQ-5D-5L, EuroQoL 5-Dimension 5-Level; JOA, Japan Orthopaedic Association.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePersistent postoperative pain was associated with poor treatment outcomes. The preoperative factors related to persistent postoperative pain included the presence of signal intensity changes on MRI (P group: 80.9 vs. N group: 59.2, p\u0026thinsp;=\u0026thinsp;0.020; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). There were no significant differences in age, sex, BMI, or duration from symptom onset to surgery between the P and N groups.\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\u003eComparison of preoperative parameters between the N and P groups.\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\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP group (n\u0026thinsp;=\u0026thinsp;47)\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\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.165\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\u003e42.3% (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.3% (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.0% (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.9% (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration from symptom onset to surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;18.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOssification type (OPLL/OLF/OPLL\u0026thinsp;+\u0026thinsp;OLF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.5% (16)/25.4% (18)/52.1% (37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.9% (15)/21.3% (10)/46.8% (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOssification classification (segmental/continuous/mixed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.6% (26)/32.4% (23)/31.0% (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.1% (24)/25.5% (12)/23.4% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.460\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal canal occupancy (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraspinal high-intensity area on MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.2% (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.9% (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJOA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEQ-5D-5L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow back pain VAS score (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;33.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.8\u0026thinsp;\u0026plusmn;\u0026thinsp;32.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower-extremity pain VAS score (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.6\u0026thinsp;\u0026plusmn;\u0026thinsp;33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.7\u0026thinsp;\u0026plusmn;\u0026thinsp;33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower-extremity numbness VAS score (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.2\u0026thinsp;\u0026plusmn;\u0026thinsp;33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.2\u0026thinsp;\u0026plusmn;\u0026thinsp;30.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Detection Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or percentage (number) of patients, unless otherwise indicated. The N group includes patients with NRS scores below 4 at the time of the survey, whereas the P group includes patients with NRS scores above 4 at the time of the survey.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI, body mass index; DM, diabetes mellitus; OPLL, ossification of posterior longitudinal ligamentum; OLF, ossification of ligamentum flavum; MRI, magnetic resonance imaging; JOA, Japan Orthopaedic Association; EQ-5D-5L, EuroQoL 5-Dimension 5-Level; VAS, Visual Analog Scale; NRS, Numerical Rating Scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eIllustrative cases\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eCase 1: P group, intraspinal high-intensity area on MRI\u003c/h2\u003e \u003cp\u003eThe patient was an 84-year-old male with cervical and thoracic OPLL\u0026thinsp;+\u0026thinsp;OLF and progressive myelopathy (Supplemental Figs.\u0026nbsp;1a and 2a). The most stenotic level was T8/9, and the spinal canal occupancy was 46.0% (Supplemental Figs.\u0026nbsp;1b and 2b). His BMI was 29.6 kg/m\u003csup\u003e2\u003c/sup\u003e and the duration from symptom onset to surgery was 18 months. He underwent C7\u0026ndash;T1 laminoplasty, T2\u0026ndash;L1 posterior decompression, and fixation with instrumentation (Supplemental Figs.\u0026nbsp;1c\u0026ndash;d and 2c\u0026ndash;d). An intraspinal high-intensity area was observed on the MRI before and after the surgery (Supplemental Fig.\u0026nbsp;1a\u0026ndash;d). From before surgery to 8 years after surgery, the NRS score, Pain Detection Score, leg pain VAS score, leg numbness VAS score, EQ-5D-5L score, and JOA score shifted from 8 to 8, from 15 to 16, from 10 to 80, from 15 to 80, from 0.96 to 0.31, and from 6 to 6, respectively. At 10 years postoperatively, acetaminophen and gabapentinoids were used, the JOA recovery rate was 0%, treatment satisfaction was 45, and pain satisfaction was 70.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eCase 2: N group, no intraspinal high-intensity area on MRI\u003c/h2\u003e \u003cp\u003eThe patient was a 61-year-old female with cervical and thoracic OPLL\u0026thinsp;+\u0026thinsp;OLF and progressive myelopathy (Supplemental Figs.\u0026nbsp;3a and 4a). The most stenotic level was T4/5, and the spinal canal occupancy was 77.7% (Supplemental Figs.\u0026nbsp;3b and 4b). Her BMI was 29.1 kg/m\u003csup\u003e2\u003c/sup\u003e and the duration from symptom onset to surgery was 12 months. She underwent C6\u0026ndash;T1 laminoplasty, T2\u0026ndash;9 posterior decompression, and fixation with instrumentation (Supplemental Figs.\u0026nbsp;3c\u0026ndash;d and 4c\u0026ndash;d). There were no high-intensity intraspinal areas on MRI before or after surgery (Supplemental Fig.\u0026nbsp;3a\u0026ndash;d). From before surgery to 10 years after surgery, the NRS score, Pain Detection Score, leg pain VAS score, leg numbness VAS score, EQ-5D-5L score, and JOA score shifted from 3 to 0, from 5 to 6, from 15 to 0, from 90 to 15, from 0.12 to 0.84, and from 3 to 5, respectively. At 10 years postoperatively, no analgesics were used, the JOA recovery rate was 25%, treatment satisfaction was 100, and pain satisfaction was 100.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the postoperative treatment outcomes of patients who underwent surgery for thoracic OPLL and OLF, with a focus on patient satisfaction, pain satisfaction, JOA score, and various pain-related indices. Although there have been reports on the relationship between pain and QOL in cervical spine diseases, to the best of our knowledge, this is the first study to investigate this relationship in thoracic ligament ossification.\u003csup\u003e10 12\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePatient satisfaction was most associated with pain management. It was observed that in cases where postoperative pain persisted, patient satisfaction and QOL were lower; thus, the importance of appropriate assessment and management of NeP was highlighted. In cases where the postoperative NRS score was \u0026ge;\u0026thinsp;4, there were elements of NeP that indicated poor treatment outcomes. Furthermore, preoperative signal intensity changes on MRI were associated with residual postoperative pain. These findings suggest that pain management plays an important role in the QOL and patient satisfaction after surgery for thoracic ligament ossification, with a worse prognosis in patients with a NeP component and more residual pain in patients with MRI intensity changes.\u003c/p\u003e \u003cp\u003eOutcomes collected directly from patients without interpretation of healthcare providers are known as patient-reported outcomes.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Although medical technology can measure the physical, physiological, and biochemical data of patients, these data cannot adequately represent patient suffering.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Pain is a multifaceted and subjective outcome that is difficult to measure from the perspective of medical technology or healthcare providers.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Therefore, patient-reported outcomes can provide more accurate information about the impact of pain in individuals.\u003c/p\u003e \u003cp\u003eThe results of this study show that patient satisfaction is mostly related to pain, implying that pain management significantly influences the overall satisfaction of patients with their treatment. Previous studies have reported that among patients with cervical OPLL, those with lower satisfaction experienced significantly more pain.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Most patients with chronic pain and spinal-related issues are affected in their physical activities.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e These findings are congruent to the patients in this study with thoracic OPLL.\u003c/p\u003e \u003cp\u003eChronic NeP has a greater impact on the QOL, psychological distress, and social functioning of patients,\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e and inadequate management can significantly affect patient satisfaction. It was found that the intensity of pain was higher in participants with NeP than in patients without NeP.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e In this study, a higher proportion of NeP was observed in patients with an NRS score of \u0026ge;\u0026thinsp;4.\u003c/p\u003e \u003cp\u003eThe prevalence of NeP in Asia has been reported to be 3.2%.\u003csup\u003e18\u003c/sup\u003e The prevalence of NeP in patients with thoracic OPLL was 39.8% preoperatively and 23.7% postoperatively, which was significantly higher than that of previous studies. Among patients with chronic pain, 20% were diagnosed with NeP,\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e and among patients with spinal diseases, 53.3% were reported to have NeP,\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e which indicates the high proportion of NeP in spinal diseases. In pain management, the use of specialized treatments for the nervous system, in addition to standard analgesics, has been shown to be effective especially for NeP.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e In this study, gabapentinoid use was more common in patients with NeP. Psychological support, physical therapy, and lifestyle modifications are also necessary for a multifaceted approach to improving pain satisfaction.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e The primary objective of chronic pain treatment is to eliminate pain, restore normal function, reduce comorbid conditions, such as depression, anxiety disorders, and sleep disorders, and improve the QOL of patients. Healthcare providers must carefully consider the pain experienced by the patients, and recognize the specific type of pain in order to provide appropriate management directed at the underlying cause.\u003c/p\u003e \u003cp\u003eWe also examined the types of medications used postoperatively, which showed that the use of medication did not directly affect patient satisfaction, suggesting that the choice and use of appropriate medication, and not the use of the medication itself, is important. Controlling pain to an NRS score of \u0026lt;\u0026thinsp;4 may contribute to improving patient satisfaction.\u003c/p\u003e \u003cp\u003eThe only preoperative factor related to residual postoperative pain was the change in MRI signal intensity. Changes in the MRI signal intensity in spinal diseases have been associated with chronic NeP, which may reflect damage to or degeneration of the spinal cord and nerve tissue that may affect the course of postoperative residual pain.\u003csup\u003e23 24 25\u003c/sup\u003e High signal intensity changes on MRI have been reported to be associated with severe spinal cord injury\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e and are related to clinical outcomes in spinal diseases.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Intramedullary signal intensity changes on MRI were associated with NeP.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Similar associations have been observed in patients with thoracic ligament ossification. Subtle findings, such as changes in signal intensity on MRI, are important indicators for predicting the risk of postoperative pain and for formulating appropriate treatment plans.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the sample size was small, which restricts the generalizability of the results. However, the study was conducted at multiple facilities, and the number of cases of thoracic ligament ossification was relatively large. The study was limited to surgical cases and no comparison was made with conservative treatment, which would have emphasized the significance of surgical treatment. The assessment of pain relied on quantitative scales, such as the NRS score and Pain Detection Score, but these scales may not fully capture the complexity and multifaceted nature of pain. Long-term follow-up studies are needed to obtain detailed information on treatment effects and complication rates, which are crucial for developing strategies for progressive diseases, such as OPLL.\u003c/p\u003e \u003cp\u003eIn conclusion, this study elucidated factors related to patient satisfaction after surgical treatment in patients with thoracic OPLL and OLF. Pain management and assessment of NeP significantly influenced patient satisfaction. These findings have important implications in the development of future treatment approaches.\u003c/p\u003e "},{"header":"Methods","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eThe present study included patients who underwent surgery for thoracic OPLL or OLF at participating facilities. Patients were surveyed at more than 1 year postoperatively from July 2022 to July 2023. This study was approved by the Institutional Review Board of the Nagoya University Graduate School of Medicine (2005-0354-7). All study participants provided informed consent. All methods were performed in accordance with the principle of the Declaration of Helsinki and Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eClinical and imaging data\u003c/h2\u003e \u003cp\u003eData collected from the medical records included age, sex, body mass index (BMI), preexisting conditions, such as diabetes mellitus (DM), duration of illness before surgery, preoperative JOA score, surgical procedure, surgical level, and preoperative imaging findings. Imaging findings included ossification sites (OPLL, OLF, and OPLL\u0026thinsp;+\u0026thinsp;OLF), ossification types (segmental, continuous, and mixed), spinal canal occupancy rate (calculated from computed tomography scans, which measured the narrowest axial spinal canal anteroposterior diameter and the anteroposterior diameter of ossification), and the presence or absence of intramedullary signal changes on magnetic resonance imaging (MRI). Postoperative neurological deterioration was assessed by worsening muscle manual testing by one or more compared to the preoperative status.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire survey\u003c/h2\u003e \u003cp\u003eThe survey included questions on the type of analgesics used at the time of the survey, treatment satisfaction (0\u0026ndash;100), pain satisfaction (0\u0026ndash;100), JOA score, Pain Detection Score, Numerical Rating Scale (NRS) score (0\u0026ndash;10), back pain Visual Analog Scale (VAS) score (0\u0026ndash;100 mm), leg pain VAS score (0\u0026ndash;100 mm), leg numbness VAS score (0\u0026ndash;100 mm), and EuroQoL 5-Dimension 5-Level score (EQ-5D-5L). The preoperative status was also surveyed for the Pain Detection Score, NRS score, back pain VAS score, leg pain VAS score, leg numbness VAS score, and EQ-5D-5L score. The JOA score was evaluated (maximum 11 points), and the postoperative JOA recovery rate was calculated as follows: (postoperative - preoperative JOA score) \u0026times; 100 / (maximum JOA score - preoperative JOA score).\u003c/p\u003e \u003cp\u003eThe Japanese version of the Pain Detection Score was used to assess the presence of neuropathic pain,\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e which consisted of nine self-reported questionnaire items, including seven weighted sensory descriptor items and two items related to the spatial and temporal characteristics of the pain pattern of an individual. Participants were categorized into three groups based on their scores: \u0026lt;13 indicating non-neuropathic pain (NeP), \u0026ge;\u0026thinsp;13 but \u0026lt;\u0026thinsp;19 indicating suspected NeP, and \u0026ge;\u0026thinsp;19 indicating NeP. Patients with scores of \u0026ge;\u0026thinsp;13 were classified into the NeP group, while those with scores\u0026thinsp;\u0026lt;\u0026thinsp;13 were placed in the non-NeP group, following the methodology of previous studies.\u003csup\u003e28 20 29\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS for Windows version 28 (IBM Corp.). The Mann\u0026ndash;Whitney U test and chi-square test were used, and statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The receiver operating characteristic (ROC) analysis was conducted to determine the cut-off NRS score for determining the presence of NeP. The NRS scores served as the test variable, whereas the binary classification was determined by the presence or absence of NeP, as defined by the Pain Detection Score. The sensitivity and specificity of each possible cut-off point for the NRS score were calculated. The ROC curve was generated by plotting the sensitivity against the 1-specificity at various threshold settings of the NRS score. The area under the ROC curve (AUC) was calculated to measure the accuracy of the NRS as a test for NeP. The optimal cut-off point for the NRS score was determined as the point on the curve closest to the top-left corner, which represented the best balance of sensitivity and specificity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eDisclaimer\u003c/h2\u003e \u003cp\u003eThe manuscript submitted does not contain information about medical devices/drugs.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThis work was supported by the Japan Agency for Medical Research and Development (grant number JP21ek010954) and Health and Labor Science Research Grants (grant number 40).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e The study was approved by the Institutional Review Board of the Nagoya University Graduate School of Medicine (2005-0354-7). Informed consent was obtained from each patient prior to inclusion in the study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by the Japan Agency for Medical Research and Development (grant number JP21ek010954) and Health and Labor Science Research Grants (grant number 40).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.It.: Conception and design, drafting of the manuscript, statistical analysis. H.Nakas.: Conception and design, critical revision. T.E.: Acquisition and data, review submitted manuscript. M.M.: Acquisition and data, review submitted manuscript. G.I.: Acquisition and data, review submitted manuscript. M.K.: Acquisition and data, review submitted manuscript. S.K.: Acquisition and data, review submitted manuscript. S.T.: Acquisition and data, review submitted manuscript. T.H.: Acquisition and data, review submitted manuscript. K.M.: Acquisition and data, review submitted manuscript. H.Nakaj.: Acquisition and data, review submitted manuscript. K.K.: Acquisition and data, review submitted manuscript. S.D.: Acquisition and data, review submitted manuscript. M.T.: Acquisition and data, review submitted manuscript. T.Y.: Acquisition and data, review submitted manuscript. M.Y.: Supervision. S.Im.: Supervision.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis work was supported by the Japan Agency for Medical Research and Development (grant number JP21ek010954) and Health and Labor Science Research Grants (grant number 40).\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBarnett, G. H., Hardy, R. W. Jr., Little, J. R., Bay, J. W. \u0026amp; Sypert, G. W. Thoracic spinal canal stenosis. \u003cem\u003eJ. Neurosurg.\u003c/em\u003e \u003cb\u003e66\u003c/b\u003e, 338\u0026ndash;344. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/jns.1987.66.3.0338\u003c/span\u003e\u003cspan address=\"10.3171/jns.1987.66.3.0338\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1987).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiyasaka, K. et al. Myelopathy due to ossification or calcification of the ligamentum flavum: radiologic and histologic evaluations. \u003cem\u003eAJNR Am. J. Neuroradiol.\u003c/em\u003e \u003cb\u003e4\u003c/b\u003e, 629\u0026ndash;632 (1983).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDommisse, G. F. The blood supply of the spinal cord. A critical vascular zone in spinal surgery. \u003cem\u003eJ. Bone Joint Surg. Br.\u003c/em\u003e \u003cb\u003e56\u003c/b\u003e, 225\u0026ndash;235 (1974).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAizawa, T. et al. Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. \u003cem\u003eJ. Neurosurg. Spine\u003c/em\u003e. \u003cb\u003e7\u003c/b\u003e, 13\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/spi-07/07/013\u003c/span\u003e\u003cspan address=\"10.3171/spi-07/07/013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamazaki, M. et al. Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament: a case report. \u003cem\u003eSpine (Phila Pa\u003c/em\u003e) 30, E343-346, ) 30, E343-346, (1976). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/01.brs.0000166504.31627.06\u003c/span\u003e\u003cspan address=\"10.1097/01.brs.0000166504.31627.06\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirabayashi, S., Kitagawa, T., Yamamoto, I., Yamada, K. \u0026amp; Kawano, H. Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach. \u003cem\u003eSpine Surg. Relat. Res.\u003c/em\u003e \u003cb\u003e2\u003c/b\u003e, 169\u0026ndash;176. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22603/ssrr.2017-0044\u003c/span\u003e\u003cspan address=\"10.22603/ssrr.2017-0044\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImagama, S. et al. Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study. \u003cem\u003eSpine (Phila Pa\u003c/em\u003e) 43, E1389-E1397, ) 43, E1389-E1397, (1976). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/BRS.0000000000002703\u003c/span\u003e\u003cspan address=\"10.1097/BRS.0000000000002703\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinkelstein, J. A. \u0026amp; Schwartz, C. E. Patient-reported outcomes in spine surgery: past, current, and future directions. \u003cem\u003eJ. Neurosurg. Spine\u003c/em\u003e. \u003cb\u003e31\u003c/b\u003e, 155\u0026ndash;164. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/2019.1.Spine18770\u003c/span\u003e\u003cspan address=\"10.3171/2019.1.Spine18770\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakashima, H. et al. Comparison of Outcomes of Surgical Treatment for Ossification of the Posterior Longitudinal Ligament Versus Other Forms of Degenerative Cervical Myelopathy: Results from the Prospective, Multicenter AOSpine CSM-International Study of 479 Patients. \u003cem\u003eJ. Bone Joint Surg. Am.\u003c/em\u003e \u003cb\u003e98\u003c/b\u003e, 370\u0026ndash;378. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2106/jbjs.O.00397\u003c/span\u003e\u003cspan address=\"10.2106/jbjs.O.00397\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagoshi, N. et al. Clinical Indicators of Surgical Outcomes After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study. \u003cem\u003eSpine (Phila Pa. 1976)\u003c/em\u003e. \u003cb\u003e47\u003c/b\u003e, 1077\u0026ndash;1083. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/brs.0000000000004359\u003c/span\u003e\u003cspan address=\"10.1097/brs.0000000000004359\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenjamin, D. et al. Recovery priorities in degenerative cervical myelopathy: a cross-sectional survey of an international, online community of patients. \u003cem\u003eBMJ Open.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e, e031486. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2019-031486\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2019-031486\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiyagi, M. et al. Residual Neuropathic Pain in Postoperative Patients With Cervical Ossification of Posterior Longitudinal Ligament. \u003cem\u003eClin. Spine Surg.\u003c/em\u003e \u003cb\u003e36\u003c/b\u003e, E277\u0026ndash;e282. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/bsd.0000000000001449\u003c/span\u003e\u003cspan address=\"10.1097/bsd.0000000000001449\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeshpande, P. R., Rajan, S. \u0026amp; Sudeepthi, B. L. Abdul Nazir, C. P. Patient-reported outcomes: A new era in clinical research. \u003cem\u003ePerspect. Clin. Res.\u003c/em\u003e \u003cb\u003e2\u003c/b\u003e, 137\u0026ndash;144. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/2229-3485.86879\u003c/span\u003e\u003cspan address=\"10.4103/2229-3485.86879\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKenna, S. P. Measuring patient-reported outcomes: moving beyond misplaced common sense to hard science. \u003cem\u003eBMC Med.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1741-7015-9-86\u003c/span\u003e\u003cspan address=\"10.1186/1741-7015-9-86\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Moraes Vieira, E. B., Garcia, J. B., da Silva, A. A., Ara\u0026uacute;jo, M., Jansen, R. C. \u0026amp; R. L. \u0026amp; Prevalence, characteristics, and factors associated with chronic pain with and without neuropathic characteristics in S\u0026atilde;o Lu\u0026iacute;s, Brazil. \u003cem\u003eJ. Pain Symptom Manage.\u003c/em\u003e \u003cb\u003e44\u003c/b\u003e, 239\u0026ndash;251. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpainsymman.2011.08.014\u003c/span\u003e\u003cspan address=\"10.1016/j.jpainsymman.2011.08.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujimori, T. et al. Patient satisfaction with surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament. \u003cem\u003eJ. Neurosurg. Spine\u003c/em\u003e. \u003cb\u003e14\u003c/b\u003e, 726\u0026ndash;733. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/2011.1.Spine10649\u003c/span\u003e\u003cspan address=\"10.3171/2011.1.Spine10649\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakajima, H. et al. Multicenter cross-sectional study of the clinical features and types of treatment of spinal cord-related pain syndrome. \u003cem\u003eJ. Orthop. Sci.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e, 798\u0026ndash;804. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jos.2019.01.012\u003c/span\u003e\u003cspan address=\"10.1016/j.jos.2019.01.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInoue, S., Taguchi, T., Yamashita, T., Nakamura, M. \u0026amp; Ushida, T. The prevalence and impact of chronic neuropathic pain on daily and social life: A nationwide study in a Japanese population. \u003cem\u003eEur. J. Pain\u003c/em\u003e. \u003cb\u003e21\u003c/b\u003e, 727\u0026ndash;737. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ejp.977\u003c/span\u003e\u003cspan address=\"10.1002/ejp.977\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo, N., Johnson, J. A., Shaw, J. W., Feeny, D. \u0026amp; Coons, S. J. Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index. \u003cem\u003eMed. Care\u003c/em\u003e. \u003cb\u003e43\u003c/b\u003e, 1078\u0026ndash;1086. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/01.mlr.0000182493.57090.c1\u003c/span\u003e\u003cspan address=\"10.1097/01.mlr.0000182493.57090.c1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakamura, M. et al. Investigation of chronic musculoskeletal pain (third report): with special reference to the importance of neuropathic pain and psychogenic pain. \u003cem\u003eJ. Orthop. Sci.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e, 667\u0026ndash;675. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00776-014-0567-6\u003c/span\u003e\u003cspan address=\"10.1007/s00776-014-0567-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamashita, T., Takahashi, K., Yonenobu, K. \u0026amp; Kikuchi, S. Prevalence of neuropathic pain in cases with chronic pain related to spinal disorders. \u003cem\u003eJ. Orthop. Sci.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e, 15\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00776-013-0496-9\u003c/span\u003e\u003cspan address=\"10.1007/s00776-013-0496-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoliakov, I. \u0026amp; Toth, C. The impact of pain in patients with polyneuropathy. \u003cem\u003eEur. J. Pain\u003c/em\u003e. \u003cb\u003e15\u003c/b\u003e, 1015\u0026ndash;1022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejpain.2011.04.013\u003c/span\u003e\u003cspan address=\"10.1016/j.ejpain.2011.04.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMizuno, J., Nakagawa, H., Inoue, T. \u0026amp; Hashizume, Y. Clinicopathological study of snake-eye appearance in compressive myelopathy of the cervical spinal cord. \u003cem\u003eJ. Neurosurg.\u003c/em\u003e \u003cb\u003e99\u003c/b\u003e, 162\u0026ndash;168. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/spi.2003.99.2.0162\u003c/span\u003e\u003cspan address=\"10.3171/spi.2003.99.2.0162\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2003).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Mefty, O., Harkey, L. H., Middleton, T. H., Smith, R. R. \u0026amp; Fox, J. L. Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging. \u003cem\u003eJ. Neurosurg.\u003c/em\u003e \u003cb\u003e68\u003c/b\u003e, 217\u0026ndash;222. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/jns.1988.68.2.0217\u003c/span\u003e\u003cspan address=\"10.3171/jns.1988.68.2.0217\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1988).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOhshio, I., Hatayama, A., Kaneda, K., Takahara, M. \u0026amp; Nagashima, K. Correlation between histopathologic features and magnetic resonance images of spinal cord lesions. \u003cem\u003eSpine (Phila Pa. 1976)\u003c/em\u003e. \u003cb\u003e18\u003c/b\u003e, 1140\u0026ndash;1149. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00007632-199307000-00005\u003c/span\u003e\u003cspan address=\"10.1097/00007632-199307000-00005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1993).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYukawa, Y., Kato, F., Yoshihara, H., Yanase, M. \u0026amp; Ito, K. MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. \u003cem\u003eSpine (Phila Pa. 1976)\u003c/em\u003e. \u003cb\u003e32\u003c/b\u003e, 1675\u0026ndash;1678. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/BRS.0b013e318074d62e\u003c/span\u003e\u003cspan address=\"10.1097/BRS.0b013e318074d62e\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2007). discussion 1679.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsubayashi, Y. et al. Validity and reliability of the Japanese version of the painDETECT questionnaire: a multicenter observational study. \u003cem\u003ePLoS One\u003c/em\u003e. \u003cb\u003e8\u003c/b\u003e, e68013. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0068013\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0068013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHochman, J. R., Davis, A. M., Elkayam, J., Gagliese, L. \u0026amp; Hawker, G. A. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. \u003cem\u003eOsteoarthr. Cartil.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 1236\u0026ndash;1242. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.joca.2013.06.023\u003c/span\u003e\u003cspan address=\"10.1016/j.joca.2013.06.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoop, S. M., ten Klooster, P. M., Vonkeman, H. E., Steunebrink, L. M. \u0026amp; van de Laar, M. A. Neuropathic-like pain features and cross-sectional associations in rheumatoid arthritis. \u003cem\u003eArthritis Res. Ther.\u003c/em\u003e \u003cb\u003e17\u003c/b\u003e, 237. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13075-015-0761-8\u003c/span\u003e\u003cspan address=\"10.1186/s13075-015-0761-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7438838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7438838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSurgical treatment for thoracic ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF) is effective but carries risks, and its impact on long-term quality of life (QOL) and satisfaction remains unclear. This study evaluated postoperative outcomes, including pain management, QOL, and treatment satisfaction, in patients undergoing thoracic ligament ossification surgery. This retrospective study included patients who underwent surgery for thoracic OPLL or OLF and were followed for over a year. Patient demographics, clinical and imaging findings, and postoperative outcomes were collected. Outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, Pain Detection Score, Numerical Rating Scale (NRS), and EuroQoL 5-Dimension 5-Level (EQ-5D-5L). Among 118 patients analyzed, postoperative improvements in JOA, EQ-5D-5L, and pain-related indices were observed. Satisfaction correlated strongly with pain satisfaction, EQ-5D-5L, and NRS scores. Receiver operating characteristic (ROC) analysis identified an NRS score of 3.5 as the cut-off for significant neuropathic pain. Patients with NRS\u0026thinsp;\u0026ge;\u0026thinsp;4 reported lower satisfaction and QOL, with more preoperative MRI signal changes. In conclusion, effective pain management, particularly addressing neuropathic pain, is crucial for improving QOL and satisfaction after thoracic ligament ossification surgery. Enhanced pain control and functional recovery are key to achieving better outcomes.\u003c/p\u003e","manuscriptTitle":"Impact of postoperative pain on patient satisfaction and quality of life after surgery for thoracic OPLL and OLF","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 01:19:27","doi":"10.21203/rs.3.rs-7438838/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-14T05:02:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239488010584921921478525777770982199331","date":"2025-12-23T04:29:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-22T12:47:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-28T11:41:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T05:14:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-26T09:49:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-08-23T05:41:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc02d59f-a6d9-4749-a1bd-c7a20afc46b9","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":60100310,"name":"Health sciences/Diseases"},{"id":60100311,"name":"Health sciences/Health care"},{"id":60100312,"name":"Health sciences/Medical research"},{"id":60100313,"name":"Health sciences/Neurology"},{"id":60100314,"name":"Biological sciences/Neuroscience"},{"id":60100315,"name":"Health sciences/Signs and symptoms"}],"tags":[],"updatedAt":"2025-12-30T01:19:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 01:19:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7438838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7438838","identity":"rs-7438838","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}