Efficacy Analysis of High-Intensity Laser Therapy for Post Lumbar Surgery Syndrome: A Randomized Controlled Trial Study

Efficacy Analysis of High-Intensity Laser Therapy for Post Lumbar Surgery Syndrome: A Randomized Controlled Trial Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy Analysis of High-Intensity Laser Therapy for Post Lumbar Surgery Syndrome: A Randomized Controlled Trial Study Ruizhao Zhao, Junjie Qiao, Xinyao Lv, Xiutong Fang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5770330/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aims to investigate the efficacy of high-intensity laser treatment against post-lumbar surgery syndrome (PLSS) through a randomized controlled trial. Method PLSS admitted at our hospital between 2020 and 2022 were recruited and randomly divided into two groups, i.e., the oral medication group (Group A) and the high-intensity laser therapy group (Group B). We analyzed the visual analog scale (VAS) and Oswestry Disability Index (ODI) of both groups. We also analyzed serum pain indicators and the extent of paraspinal muscle fat infiltration before and after treatment, at one week, one month, three months, six months, and twelve months post-treatment. Results After one month, three months, and six months post-treatment, VAS scores of Group B were significantly lower than those of Group A ( P < 0.05). After one week, one month, and twelve months post-treatment, the ODI of Group B was significantly lower than that of Group A ( P < 0.05). One month after treatment, Group B patients had significantly lower levels of 5-HT and substance P (SP) than Group A ( P < 0.05). The content of β-endorphins (β-EP) in the blood of Group B was higher than that of Group A ( P = 0.018). The progression of paraspinal muscle fat infiltration in Group B was significantly slower than that in Group A ( P = 0.001). Conclusion HILT can improve the clinical symptoms of patients with PLSS, delay the degenerative changes in the paraspinal muscles of the lumbar spine, and improve the long-term postoperative quality of life of patients. Post Lumbar Surgery Syndrome Gabapentin High-Intensity Laser Therapy Paraspinal Muscle Fat Infiltration Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. Introduction Post Lumbar Surgery Syndrome (PLSS) is a condition in which patients experience incomplete pain relief after lumbar surgery (including laminectomy, spinal fusion with internal fixation, and nuclectomy among others). In this condition, patients also develop similar lower back and sacral pain as well as discomfort before surgery or are accompanied by radiating pain and numbness in the buttocks and lower limbs. PLSS is one of the most prevalent long-term complications following lumbar surgery.Treatment solutions for PLSS are primarily divided into surgical and non-surgical treatments. Surgical treatments primarily include re-treatment of the original disease and adhesiolysis of pathological tissue adhesions (including Percutaneous Release of Epidural Scar Adhesions). 1 On the other hand, non-surgical treatments comprise symptomatic pain relief, functional exercises, and physical therapy. Gabapentin, which was initially used as an adjuvant treatment for epileptic seizures is commonly used for various types of pain, such as treating chronic lower back pain. 2 Although such drugs have a high safety profile and are well-tolerated, a few patients still abuse them, causing severe adverse events including dizziness, falls, somnolence, and ataxia. 3 Therefore, there is a need to identify alternative treatments. As a non-invasive and painless physical therapy technique, HILT can promote blood circulation, reduce the release of inflammatory factors, and promote the release of local endorphins through local high-energy irradiation, thereby playing an analgesic role. 4,5 This work aims to explore the efficacy of HILT for PLSS through a randomized controlled trial. 2. Materials and methods 2.1 Subjects and Study Design This is a single-blind, randomized controlled trial, which enrolled 100 patients who underwent lumbar internal fixation surgery at Beijing shijitan hospital between 2020 and 2022. The inclusion criteria included: ① Patients meeting the diagnostic criteria for PLSS; ② Those with no mental or cognitive impairments; ③ Complete clinical medical records and follow-up data; ④ High treatment compliance, voluntary participation. The exclusion criteria included: ① Patients allergic to the drugs used in this study or photosensitive; ② those diagnosed with infectious or traumatic skin diseases; ③ Currently diagnosed with malignant tumors or with a history of malignant tumors; ④ Received any drug or physical therapy for pain within the last week; Patients with severe liver, kidney, and cardiovascular diseases. Using a random number table method, the patients were randomly divided into an oral medication group (Group A) and a HILT group (Group B). Group A comprised 26 males and 24 females with an average age of 67.76 ± 5.22 years, whereas Group B consisted of 25 males and 25 females with an average age of 69.66 ± 5.96 years. All the patients signed an informed consent form before the start of the experiment. The study protocol was reviewed and approved by the Medical Ethics Committee of Beijing Century Tun Hospital affiliated with Capital Medical University (Ethics Approval Number: sjtkyl1-1x-2023(044)). Patients had the choice to withdraw at any time during the experimental process (Fig. 1 ). Table 1. Comparison of Baseline Clinical Characteristics Group A(n = 50) Group B(n = 50) t/Z/ \(\:\chi\:\) 2 P Age(year) 67.76 ± 5.22 69.66 ± 5.961 1.696 0.093 Gender 0.040 0.842 Male 26(52%) 25(50%) Female 24(48%) 25(50%) BMI(kg/m 2 ) 25.86 ± 5.01 24.43 ± 6.63 -1.340 0.183 Symptom duration(w) 12.68 ± 2.91 12.9 ± 3.18 0.361 0.769 Operation segment 0.555 0.907 L3-5 12(24.0%) 13(26.00%) L4-5 10(20.0%) 12(24.0%) L4-S1 13(26.0%) 13(26.0%) L5-S1 15(30.0%) 12(24.0%) Surgery 1.399 0.706 PTED 10(20.0%) 15(30.0%) Lumbar Laminectomy 11(22.0%) 9(18.0%) PLIF&CBT 16(32.0%) 15(30.0%) PLIF&PS 13(26.0%) 11(22.0%) Comorbidity 7.789 0.051 T2DM 20(40.0%) 9(18.0%) Hypertension 8(16.0%) 15(30.0%) CAD 11(22.0%) 17(34.0%) Health 11(22.0%) 9(18.0%) PTED, Percutaneous Transforaminal Endoscopic Discectomy PLIF&CBT, Posterior Lumbar Interbody Fusion& Cortical Bone Trajectory PLI F&PS, Posterior Lumbar Interbody Fusion & Pedicle Screw T2DM, Diabetes mellitus type 2 CAD, Coronary Atherosclerotic Heart Disease 2.2 Therapeutic Methods 2.2.1 HILT Before the treatment, patients were asked to lay prone on the treatment table (those who had difficulty with the prone position chose the lateral position), with both upper limbs naturally placed alongside their bodies. The original surgical stage and the painful area were located, and the two stages above and below the original surgical segment and the areas to the left and right of the scapular lines were designated as the laser treatment areas. The LTS-1500 high-intensity laser therapy device (LITE-CURE company, USA) was used, with a wavelength of 1064 nm, a power of 12 W, and a treatment mode of continuous bio-stimulation. The device was positioned above the treatment area, and the contact treatment head was placed close to the patient skin, moving the handle at a speed of 4–6 cm/s. The dosage was 10J/cm², with one treatment every other day for one week (i.e., 4 treatments). After each treatment, we observed whether the patient still had symptoms including redness, swelling, or pain in the irradiated area. The patient returned to the ward if there were no discomfort symptoms after 30 minutes. 2.2.2 Oral medication treatment All group A patients were orally administered with gabapentin daily (600mg, TID) for one week. (Specification: 300mg×24 capsules.) 2.3 Measurements 2.3.1 Functional Evaluation: We followed up the records of VAS scores and ODI for both groups of patients before treatment and at 1 week, 1 month, 3 months, 6 months, and 12 months after treatment. 2.3.2 Serum Pain Markers: Upon waking before treatment and 1 month after treatment, 5 ml of venous blood was drawn from both groups of patients in the fasting state. After centrifugation, the serum was separated and the levels of 5-hydroxytryptamine (5-HT), substance P (SP), and human β-endorphin (β-EP) were measured through the enzyme-linked immunosorbent assay (ELISA) method. 2.3.3 Imaging Analysis: Both patient groups underwent lumbar magnetic resonance imaging before treatment and 12 months after treatment to assess the extent of fatty infiltration in the paraspinal muscles at the L4/L5 segment. On the T2-weighted images (T2WI) of the muscles, fat components were colored red using Image J software. The pseudo-coloring technique was used to compute the percentage of the red area (representing fat) within the muscle area, which was the rate of fatty infiltration in the paraspinal muscles (Fig. 2 ). 2.4 Statistical analysis All statistical analyses and chart creation were performed using the SPSS 27.0 and Graph Prism 9.5.0 software. Normally distributed continuous data were presented as mean ± standard deviation, and comparisons between groups were conducted using independent samples t-test. Non-normally distributed continuous data were presented as M (Q1, Q3). Comparisons between groups were performed using the Wilcoxon rank-sum test. Categorical data were presented as N (%), and comparisons between groups were conducted using the Chi-square test. A p-value of 0.05), indicating comparability (Table 1). No significant differences in VAS scores and ODI were observed between the two groups before treatment. After treatment, both groups displayed a significant downward trend in VAS scores unlike before treatment ( P < 0.05); at 1 month, 3 months, and 6 months, the VAS scores of Group B were significantly lower than those of Group A ( P < 0.05). At 1 week, 1 month, and 12 months after treatment, the ODI of Group B (HILT group) was significantly lower than that of Group A (Oral Medication group) ( P < 0.05), (Figs. 3 & 4 ). 3.2 Serological Pain Markers Before treatment, both groups had comparable levels of 5-HT, SP, and β-EP in their fasting venous blood ( P < 0.05); one month after treatment, the levels of 5-HT and SP in both groups significantly decreased compared to before treatment, with Group B being significantly lower than Group A (5-HT, P = 0.044; SP, P = 0.009); one month after treatment, the content of β-EP in Group B's blood was significantly higher than that in Group A ( P = 0.018) (Fig. 5 ). 3.3 Radiological materials Before treatment, we observed no significant differences in the degree of fatty infiltration of the paraspinal muscles at the L4/L5 segment between the two groups ( P > 0.05). At the final follow-up (12 months after treatment), the degree of fatty infiltration in the paraspinal muscles of Group B (HILT group) was significantly lower than that of Group A (Oral Medication group), but without statistical significance ( P > 0.05). The progression of fatty infiltration in the paraspinal muscles of Group B was significantly slower than that of Group A ( P < 0.05) (Fig. 6 ). 4. Discussion PLSS is also referred to as Failed Back Surgery Syndrome (FBSS). 6,7 Its main causes include epidural fibrosis, disc rupture, acquired spinal stenosis, recurrent disc herniation, facet joint pain, sacroiliac joint pain, arachnoiditis, and decreased stability in the corresponding segment. 8–10 Notably, lumbar pain caused by epidural fibrosis accounts for 20%-36% of all FBSS patients. 10–12 Studies have documented that, unlike patients with osteoarthritis, rheumatoid arthritis, complex regional pain syndrome, or fibromyalgia, patients with FBSS experience more severe pain with poor quality of life and physical functioning. 13 Oral medication for pain relief and invasive treatments are the current medications for PLSS. Besides, commonly dispensed oral medications for pain relief include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, ion channel modulators, opioids, and central muscle relaxants. Of note, gabapentin is a representative of ion channel modulators. These drugs can readily result in drug tolerance and addiction; they also have more severe adverse reactions including gastrointestinal reactions and central nervous system side effects. Invasive treatments primarily include percutaneous spinal endoscopic adhesiolysis, epidural injections of steroids, local anesthetics, hypertonic saline solutions, and revision surgery for the underlying disease. 14 Although those treatments can alleviate some symptoms, the long-term efficacy remains controversial, and patients have a low acceptance of invasive treatment methods. Gabapentin is a drug approved in China for the adjuvant treatment of partial seizures and postherpetic neuralgia. It has also been approved in Europe against diabetic peripheral neuropathic pain. The off-label use of gabapentin for various pain conditions is becoming increasingly common despite its analgesic effects. 15 As a structural analog of gamma-aminobutyric acid (GABA), gabapentin is in an inactive state and only becomes active by binding to the α2δ subunit of the presynaptic membrane calcium channel, thereby suppressing the influx of calcium ions and reducing the release of pain-causing substances. Gabapentin can also inhibit the activity of N-methyl-D-aspartate (NMDA) receptors, reducing the influx of Ca 2+ and Na + as well as the efflux of K + , thereby reducing the abnormal neuronal firing induced by high calcium conductance and the resulting seizures and neuropathic pain. 16–18 The specific mechanisms by which gabapentin causes abuse are unclear; however, they may be associated with GABA receptor mediation. Other GABA receptor-modulating drugs also prone to abuse include alcohol, benzodiazepines, and sleeping pills. 15 Regardless of whether they are used alone or combined with other medications, gabapentin can yield satisfactory therapeutic effects in the treatment of lower back pain; this is consistent with the present study findings. 19,20 Additionally, other studies have indicated that gabapentin does not alleviate lower back pain symptoms and increases adverse reactions including dizziness, headache, nausea, as well as impaired consciousness. Therefore, this study sought to identify a novel, economical, and safe alternative therapy to oral medication for treating PLSS. This study compared the efficacy of oral gabapentin and HILT in treating postoperative lumbar pain syndrome. As a novel and green, economical physical therapy, HILT has increasingly been used in the fields of orthopedic disorders and sports medicine with early success. However, additional research is necessary to determine its precise indications, working principles, and long-term efficacy. Laser is a special type of artificial light with medical therapeutic properties, including high intensity and directionality; it is primarily divided into HILT and low-level laser therapy (LLLT). HILT is a non-invasive and painless treatment with a strong tissue penetration capacity (5 to 15 cm), that can act on deep human tissues and produce numerous photons to achieve multiple physical therapeutic effects. High-energy lasers penetrate deeper tissues at the same time reducing heat accumulation and preventing local tissue damage. The analgesic effect of HILT is based on multiple mechanisms of action, such as its capacity to reduce the production of pain substances, slow down the transmission of pain stimuli, and increase the production of morphine-like substances in the body (including β-EP). 21,22 Noteworthy, 5-HT plays a regulatory role in pain in both the peripheral and central nervous systems; its levels can be increased by the inflammation levels in patients with lumbar disc herniation. 23 Moreover, 5-HT can increase the infiltration of intervertebral nerve roots by enriching the local complement components or chemokines, hence increasing pain. Studies have shown that high-intensity laser therapy can substantially reduce the release of substance P from sensory nerve endings in the body, thereby alleviating pain. Of note, substance P activates the neurokinin-1 receptor, hence mediating pain transmission and producing hyperalgesia. 24,25 In addition, it can suppress the conduction of Aδ and C fibers, reduce the rate of neural conduction, and simultaneously disrupt neuro electrophysiological parameters, resulting in specific neural conduction blocks in nociceptors, and suppression of pain signal transmission. 26 HILT reduces bradykinin synthesis and the release of acetylcholine as well as histamine in damaged tissues through nerve fiber conduction block, hence increasing pain threshold of patients and alleviating pain. 25,27 The thermal effect produced by lasers can trigger local vasodilation, promoting rapid exchange and absorption of tissue oxygen as well as local metabolic products, allowing more oxygen into cells, participating in mitochondrial oxidative reactions, and accelerating ATP synthesis. 5,28 Several ATP molecules are used to synthesize cellular genetic material, promoting tissue repair and regeneration, at the same time also alleviating local edema. 29 The photochemical and photothermal effects of HILT can stimulate collagen production, and increase blood flow, vascular permeability, and cellular metabolism hence contributing to the repair of damaged tissues and eliminating painful stimuli. 30,31 Additionally, when the skin of a patient comes into contact with the laser, there is a generation of a special photo-pressure in the human tissue, which can suppress the release of pain-causing substances from nerves, thereby relieving pain. Herein, we found that both HILT and oral gabapentin can reduce the levels of 5-HT and SP in the body, at the same time increasing the levels of β-EP, corroborating the aforementioned research findings. Furthermore, the findings revealed that the VAS scores at the 1-month, 3-month, and 6-month follow-ups after treatment in the HILT group were significantly lower than those in the oral medication group. The ODI scores at 1 week, 1 month, and 12 months were also significantly lower than that in the oral medication group; this shows that high-intensity laser treatment can significantly relieve pain and improve the quality of life in patients with PLSS, with a greater degree of relief. Ozkaraoglu et al. randomly divided patients with lower back pain into a HILT group and a Transcutaneous Electrical Nerve Stimulation (TENS) group, both of which were subjected to exercise training, ultrasound, and heat therapy. 32 The results revealed that the degree of pain reduction in the HILT group was superior to that in the TENS group. Elsewhere, Choi et al. showed that patients with chronic back pain who received both HILT and exercise treatment experienced greater pain reduction than those who only underwent exercise therapy alone. 31 The same study did not however investigate the impact of HILT alone on pain improvement in patients, a research gap addressed by the present study. Our findings showed a delayed effect of high-intensity laser therapy, primarily due to the weak immediate analgesic effect of high-intensity laser on tissue. We noted that the long-term efficacy majorly relies on its tissue repair effect. We further conducted a quantitative statistical analysis of fat infiltration in the paraspinal muscles of the lumbar spine and discovered that HILT can significantly delay fat infiltration of paraspinal muscles. Muscle fat infiltration (MFI) is fat accumulation in the intermuscular and intramuscular adipose tissue or the form of lipid droplets within muscle cells. The paraspinal muscles of the lumbar spine primarily comprise the erector spinae and multifidus muscles, with the multifidus being a key muscle in preserving the stability of the lumbar spine. Paravertebral muscle fat infiltration (PMFI) is closely associated with lower back pain, decreased muscle strength, and endurance, which can reduce the capacity of the lumbar spine to maintain its tension. This can also decrease the capacity of paraspinal muscles to control external loads, becoming one of the important reasons prompting patients with PLSS to seek medical attention. 33,34 Fat infiltration is responsible for muscle damage, insulin resistance, and muscle dystrophy; it is also accompanied by a decline in muscle function. 35 Current research indicates that muscle fat infiltration causes an imbalance of muscle homeostasis. Skeletal muscles are inevitably damaged during lumbar spine surgery, causing an imbalance in skeletal muscle homeostasis. Endothelial cells, fibroadipogenic progenitors (FAPs), immune cells, pericytes, tendon cells, and nerve-related cells interact with each other, promoting muscle fat infiltration. 36 Additional studies have shown that patients with an FI of 25% or more have a significantly higher rate of spinal fusion failure than those with an FI of less than 25%. Severe PMFI may be a potential risk factor for spinal fusion failure. 37 After lumbar spine surgery, delaying paraspinal muscle fat infiltration is thus one of the important factors contributing to improved quality of life and reducing long-term postoperative complications. Studies on paraspinal muscle fat infiltration are limited, and there is no definitive treatment plan. Although HILT cannot reverse paraspinal muscle fat infiltration, we found that it can slow the process of muscle degeneration and can be future research directions on paraspinal muscle degeneration. This is because: (1) HILT can accelerate metabolism of paraspinal skeletal muscle cells, quickly clear metabolic toxins, promote the recovery of cellular and organelle functions, and delay cellular degeneration; (2) HILT can reduce the release of inflammatory mediators, resulting in less cellular degeneration; (3) HILT can promote collagen synthesis and fibrotic processes, accelerating the repair and regeneration of fibrous tissues; (4) After relieving pain, HILT allows the recovery of paraspinal muscle activation in daily life, thereby increasing muscle cell contraction and slowing down muscle degeneration. Limitations This study has limitations. First, regarding the single-blind study, the outcome assessor and the physical therapists who provided treatment knew the treatment group allocation, which might cause study bias. Secondly, the sample size in this study is relatively small, which may bring potential biases in the results. Thirdly, we did not investigate the optimal dosage for high-energy laser irradiation treatment. Therefore, future studies should include more patients and carry out randomized controlled trials with different high-energy laser dosage treatment groups to explore the optimal dosage of this therapy; this would promote the standardized use of high-energy laser irradiation in clinical practice. Moreover, future research should further explore molecular biological mechanisms by which high-energy lasers delay paraspinal muscle degeneration. 5. Conclusion In conclusion, we explored the efficacy of high-intensity laser irradiation in the treatment of patients with PLSS. Among PLSS patients, we unraveled that HILT can significantly improve clinical symptoms, outperforming oral gabapentin in delaying the long-term degeneration of paraspinal muscles post-surgery. We anticipate that HILT will potentially replace oral medications as a treatment against PLSS. Declarations Author Contribution R.Z. Zhao: Writing – original draft, Project administration.J.J. Qiao: Methodology, Investigation, Formal analysis, Data curation, Conceptualization.X.Y. Lv: Writing – original draft.Xiutong Fang: Visualization, Supervision, Project administration, Conceptualization. References Manchikanti, L., Manchikanti, K.N., Gharibo, C.G., and Kaye, A.D. (2016). Efficacy of Percutaneous Adhesiolysis in the Treatment of Lumbar Post Surgery Syndrome. Anesth Pain Med 6 , e26172. 10.5812/aapm.26172v2 . Evoy, K.E., Sadrameli, S., Contreras, J., Covvey, J.R., Peckham, A.M., and Morrison, M.D. (2021). Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update. Drugs 81 , 125–156. 10.1007/s40265-020-01432-7 . Hägg, S., Jönsson, A.K., and Ahlner, J. (2020). Current Evidence on Abuse and Misuse of Gabapentinoids. Drug Saf 43 , 1235–1254. 10.1007/s40264-020-00985-6 . Nazari, A., Moezy, A., Nejati, P., and Mazaherinezhad, A. (2019). 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J Back Musculoskelet Rehabil 33 , 193–199. 10.3233/bmr-181199 . Deyo, R.A., Cherkin, D., Conrad, D., and Volinn, E. (1991). Cost, controversy, crisis: low back pain and the health of the public. Annu Rev Public Health 12 , 141–156. 10.1146/annurev.pu.12.050191.001041 . Fischer, M.A., Nanz, D., Shimakawa, A., Schirmer, T., Guggenberger, R., Chhabra, A., Carrino, J.A., and Andreisek, G. (2013). Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology 266 , 555–563. 10.1148/radiol.12120399 . Goutallier, D., Postel, J.M., Bernageau, J., Lavau, L., and Voisin, M.C. (1994). Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res, 78–83. Agha, O., Diaz, A., Davies, M., Kim, H.T., Liu, X., and Feeley, B.T. (2021). Rotator cuff tear degeneration and the role of fibro-adipogenic progenitors. Ann N Y Acad Sci 1490 , 13–28. 10.1111/nyas.14437 . Han, G., Zou, D., Li, X., Zhang, S., Li, Z., Zhou, S., Li, W., Sun, Z., and Li, W. (2022). Can fat infiltration in the multifidus muscle be a predictor of postoperative symptoms and complications in patients undergoing lumbar fusion for degenerative lumbar spinal stenosis? A case-control study. J Orthop Surg Res 17 , 289. 10.1186/s13018-022-03186-2 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5770330","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":398240753,"identity":"1b140f6a-a881-45bf-9a47-c2bb2d7c01cf","order_by":0,"name":"Ruizhao Zhao","email":"","orcid":"","institution":"Beijing Shijitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ruizhao","middleName":"","lastName":"Zhao","suffix":""},{"id":398240754,"identity":"998f3211-2479-4cf3-8f2c-1fe48a43ab16","order_by":1,"name":"Junjie Qiao","email":"","orcid":"","institution":"Beijing Shijitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junjie","middleName":"","lastName":"Qiao","suffix":""},{"id":398240756,"identity":"0fc4a017-a6ac-4d07-bcc9-22c5857eceb3","order_by":2,"name":"Xinyao Lv","email":"","orcid":"","institution":"Beijing Shijitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xinyao","middleName":"","lastName":"Lv","suffix":""},{"id":398240757,"identity":"2979ec5c-90f7-4fca-9969-f8155f07bb51","order_by":3,"name":"Xiutong Fang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBAC9gYQaQDjVkjIyRPSwnMAokUCwj1jYWzYQJQWBqgWxraKRIYDhLSwnz38mqfgcB2/dPvlz4XzJBIYG5gfPrqBTwtPXprlDIPDEpJzzpRJz9wmkcfOwGZsnINHiz1DjpnBB6AWgxs5acy82ySKGRt42KTxaeHhf2NmkADRkvyZd45EYsMBQlokcowfQGxJPyDN20CUljdmjDMM0iVnzshhk55xTMLYsJmAX3j4c4w/8/yx5ueXSH/8uaCmTk6evfnhY3xagIANGo08Bsxgmhm/crCSDxCa/QERikfBKBgFo2AkAgDEYUazJZe3XgAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing Shijitan Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xiutong","middleName":"","lastName":"Fang","suffix":""}],"badges":[],"createdAt":"2025-01-06 03:38:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5770330/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5770330/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73316274,"identity":"c216ecf7-2dc0-4f33-bcfa-38106c49e4c9","added_by":"auto","created_at":"2025-01-08 20:06:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":127628,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of the study\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5770330/v1/a2f74bb10ef6ca2723edf9b7.png"},{"id":73316273,"identity":"642cd4ff-a864-4ee1-a286-abd0da2ec016","added_by":"auto","created_at":"2025-01-08 20:06:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":691722,"visible":true,"origin":"","legend":"\u003cp\u003eQuantitative analysis of fat infiltration in paraspinal muscles (multifidus and erector spinae) at the L4/L5 lumbar level using ImageJ.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5770330/v1/97dbf655a713568b7cbbcb8a.png"},{"id":73316275,"identity":"90201a67-cb24-42af-ae99-3ca657d20a61","added_by":"auto","created_at":"2025-01-08 20:06:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":175338,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of VAS Scores Between Two Groups at Pre-treatment and During Follow-up After Treatment.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5770330/v1/49322cf107a35da5eb537460.png"},{"id":73316277,"identity":"e9d01786-e397-4f57-ae69-c4a4b9d5ea8f","added_by":"auto","created_at":"2025-01-08 20:06:56","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":131571,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of ODI Between Two Groups at Pre-treatment and During Follow-up After Treatment. Data are shown as ns (not significant) = \u003cem\u003ep\u003c/em\u003e value \u0026gt;0.05, ∗ = \u003cem\u003ep\u003c/em\u003e value \u0026lt;0.05, ∗∗ = \u003cem\u003ep\u003c/em\u003e value \u0026lt;0.01, ∗∗∗ = \u003cem\u003ep\u003c/em\u003e value \u0026lt;0.001, and ∗∗∗∗ = \u003cem\u003ep\u003c/em\u003e value \u0026lt;0.0001. Group A; the Oral Medication Group; Group B; the high-intensity laser therapy Group.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-5770330/v1/aaf29e69cbb629b03918ec22.png"},{"id":73316278,"identity":"08c45853-9841-4c30-a4b7-f24b3c61a274","added_by":"auto","created_at":"2025-01-08 20:06:56","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":261925,"visible":true,"origin":"","legend":"\u003cp\u003eThe comparison of pain substances in the venous blood of two groups of patients before and after treatment.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-5770330/v1/79538ce31796fc997ab4c62e.png"},{"id":73316276,"identity":"b80ef41e-6055-4b46-a547-5025fa53319f","added_by":"auto","created_at":"2025-01-08 20:06:56","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":130934,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Fat Infiltration in Paraspinal Muscles at the L4/L5 Lumbar Level Between Two Groups of Patients ∗∗ = \u003cem\u003ep\u003c/em\u003e value \u0026lt;0.01\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-5770330/v1/51dabafc51f81c00499bcdce.png"},{"id":73712273,"identity":"55d2d9c8-9054-45ff-92b6-8f27ae5a1d85","added_by":"auto","created_at":"2025-01-13 21:46:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1834944,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5770330/v1/b19a1bfc-2272-4eee-861d-8db5a9b12e4c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy Analysis of High-Intensity Laser Therapy for Post Lumbar Surgery Syndrome: A Randomized Controlled Trial Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePost Lumbar Surgery Syndrome (PLSS) is a condition in which patients experience incomplete pain relief after lumbar surgery (including laminectomy, spinal fusion with internal fixation, and nuclectomy among others). In this condition, patients also develop similar lower back and sacral pain as well as discomfort before surgery or are accompanied by radiating pain and numbness in the buttocks and lower limbs.\u003c/p\u003e \u003cp\u003ePLSS is one of the most prevalent long-term complications following lumbar surgery.Treatment solutions for PLSS are primarily divided into surgical and non-surgical treatments. Surgical treatments primarily include re-treatment of the original disease and adhesiolysis of pathological tissue adhesions (including Percutaneous Release of Epidural Scar Adhesions).\u003csup\u003e1\u003c/sup\u003e On the other hand, non-surgical treatments comprise symptomatic pain relief, functional exercises, and physical therapy. Gabapentin, which was initially used as an adjuvant treatment for epileptic seizures is commonly used for various types of pain, such as treating chronic lower back pain.\u003csup\u003e2\u003c/sup\u003e Although such drugs have a high safety profile and are well-tolerated, a few patients still abuse them, causing severe adverse events including dizziness, falls, somnolence, and ataxia.\u003csup\u003e3\u003c/sup\u003e Therefore, there is a need to identify alternative treatments. As a non-invasive and painless physical therapy technique, HILT can promote blood circulation, reduce the release of inflammatory factors, and promote the release of local endorphins through local high-energy irradiation, thereby playing an analgesic role.\u003csup\u003e4,5\u003c/sup\u003e This work aims to explore the efficacy of HILT for PLSS through a randomized controlled trial.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Subjects and Study Design\u003c/h2\u003e \u003cp\u003eThis is a single-blind, randomized controlled trial, which enrolled 100 patients who underwent lumbar internal fixation surgery at Beijing shijitan hospital between 2020 and 2022. The inclusion criteria included: ① Patients meeting the diagnostic criteria for PLSS; ② Those with no mental or cognitive impairments; ③ Complete clinical medical records and follow-up data; ④ High treatment compliance, voluntary participation. The exclusion criteria included: ① Patients allergic to the drugs used in this study or photosensitive; ② those diagnosed with infectious or traumatic skin diseases; ③ Currently diagnosed with malignant tumors or with a history of malignant tumors; ④ Received any drug or physical therapy for pain within the last week; Patients with severe liver, kidney, and cardiovascular diseases. Using a random number table method, the patients were randomly divided into an oral medication group (Group A) and a HILT group (Group B). Group A comprised 26 males and 24 females with an average age of 67.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22 years, whereas Group B consisted of 25 males and 25 females with an average age of 69.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96 years. All the patients signed an informed consent form before the start of the experiment. The study protocol was reviewed and approved by the Medical Ethics Committee of Beijing Century Tun Hospital affiliated with Capital Medical University (Ethics Approval Number: sjtkyl1-1x-2023(044)). Patients had the choice to withdraw at any time during the experimental process (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;1. Comparison of Baseline Clinical Characteristics\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\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\u003eGroup A(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et/Z/\u003c/em\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\chi\\:\\)\u003c/span\u003e\u003c/span\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.696\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e24(48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e25.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptom duration(w)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation segment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(26.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4-S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5-S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumbar Laminectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLIF\u0026amp;CBT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(32.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLIF\u0026amp;PS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(16.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(34.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ePTED, Percutaneous Transforaminal Endoscopic Discectomy\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePLIF\u0026amp;CBT, Posterior Lumbar Interbody Fusion\u0026amp; Cortical Bone Trajectory\u003c/p\u003e \u003cp\u003ePLI F\u0026amp;PS, Posterior Lumbar Interbody Fusion \u0026amp; Pedicle Screw\u003c/p\u003e \u003cp\u003eT2DM, Diabetes mellitus type 2\u003c/p\u003e \u003cp\u003eCAD, Coronary Atherosclerotic Heart Disease\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Therapeutic Methods\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 HILT\u003c/h2\u003e \u003cp\u003eBefore the treatment, patients were asked to lay prone on the treatment table (those who had difficulty with the prone position chose the lateral position), with both upper limbs naturally placed alongside their bodies. The original surgical stage and the painful area were located, and the two stages above and below the original surgical segment and the areas to the left and right of the scapular lines were designated as the laser treatment areas. The LTS-1500 high-intensity laser therapy device (LITE-CURE company, USA) was used, with a wavelength of 1064 nm, a power of 12 W, and a treatment mode of continuous bio-stimulation. The device was positioned above the treatment area, and the contact treatment head was placed close to the patient skin, moving the handle at a speed of 4\u0026ndash;6 cm/s. The dosage was 10J/cm\u0026sup2;, with one treatment every other day for one week (i.e., 4 treatments). After each treatment, we observed whether the patient still had symptoms including redness, swelling, or pain in the irradiated area. The patient returned to the ward if there were no discomfort symptoms after 30 minutes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Oral medication treatment\u003c/h2\u003e \u003cp\u003eAll group A patients were orally administered with gabapentin daily (600mg, TID) for one week. (Specification: 300mg\u0026times;24 capsules.)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Measurements\u003c/h2\u003e \u003cp\u003e \u003cp\u003e2.3.1 Functional Evaluation: We followed up the records of VAS scores and ODI for both groups of patients before treatment and at 1 week, 1 month, 3 months, 6 months, and 12 months after treatment.\u003c/p\u003e \u003cp\u003e2.3.2 Serum Pain Markers: Upon waking before treatment and 1 month after treatment, 5 ml of venous blood was drawn from both groups of patients in the fasting state. After centrifugation, the serum was separated and the levels of 5-hydroxytryptamine (5-HT), substance P (SP), and human β-endorphin (β-EP) were measured through the enzyme-linked immunosorbent assay (ELISA) method.\u003c/p\u003e \u003cp\u003e2.3.3 Imaging Analysis: Both patient groups underwent lumbar magnetic resonance imaging before treatment and 12 months after treatment to assess the extent of fatty infiltration in the paraspinal muscles at the L4/L5 segment. On the T2-weighted images (T2WI) of the muscles, fat components were colored red using Image J software. The pseudo-coloring technique was used to compute the percentage of the red area (representing fat) within the muscle area, which was the rate of fatty infiltration in the paraspinal muscles (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses and chart creation were performed using the SPSS 27.0 and Graph Prism 9.5.0 software. Normally distributed continuous data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and comparisons between groups were conducted using independent samples t-test. Non-normally distributed continuous data were presented as M (Q1, Q3). Comparisons between groups were performed using the Wilcoxon rank-sum test. Categorical data were presented as N (%), and comparisons between groups were conducted using the Chi-square test. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Clinical efficacy\u003c/h2\u003e \u003cp\u003eA comparison of the general data between the two groups showed no statistically significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating comparability (Table\u0026nbsp;1). No significant differences in VAS scores and ODI were observed between the two groups before treatment. After treatment, both groups displayed a significant downward trend in VAS scores unlike before treatment (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); at 1 month, 3 months, and 6 months, the VAS scores of Group B were significantly lower than those of Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). At 1 week, 1 month, and 12 months after treatment, the ODI of Group B (HILT group) was significantly lower than that of Group A (Oral Medication group) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Serological Pain Markers\u003c/h2\u003e \u003cp\u003eBefore treatment, both groups had comparable levels of 5-HT, SP, and β-EP in their fasting venous blood (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); one month after treatment, the levels of 5-HT and SP in both groups significantly decreased compared to before treatment, with Group B being significantly lower than Group A (5-HT, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044; SP, P\u0026thinsp;=\u0026thinsp;0.009); one month after treatment, the content of β-EP in Group B's blood was significantly higher than that in Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Radiological materials\u003c/h2\u003e \u003cp\u003eBefore treatment, we observed no significant differences in the degree of fatty infiltration of the paraspinal muscles at the L4/L5 segment between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). At the final follow-up (12 months after treatment), the degree of fatty infiltration in the paraspinal muscles of Group B (HILT group) was significantly lower than that of Group A (Oral Medication group), but without statistical significance (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The progression of fatty infiltration in the paraspinal muscles of Group B was significantly slower than that of Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003ePLSS is also referred to as Failed Back Surgery Syndrome (FBSS).\u003csup\u003e6,7\u003c/sup\u003e Its main causes include epidural fibrosis, disc rupture, acquired spinal stenosis, recurrent disc herniation, facet joint pain, sacroiliac joint pain, arachnoiditis, and decreased stability in the corresponding segment.\u003csup\u003e8\u0026ndash;10\u003c/sup\u003e Notably, lumbar pain caused by epidural fibrosis accounts for 20%-36% of all FBSS patients.\u003csup\u003e10\u0026ndash;12\u003c/sup\u003e Studies have documented that, unlike patients with osteoarthritis, rheumatoid arthritis, complex regional pain syndrome, or fibromyalgia, patients with FBSS experience more severe pain with poor quality of life and physical functioning.\u003csup\u003e13\u003c/sup\u003e Oral medication for pain relief and invasive treatments are the current medications for PLSS. Besides, commonly dispensed oral medications for pain relief include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, ion channel modulators, opioids, and central muscle relaxants. Of note, gabapentin is a representative of ion channel modulators. These drugs can readily result in drug tolerance and addiction; they also have more severe adverse reactions including gastrointestinal reactions and central nervous system side effects. Invasive treatments primarily include percutaneous spinal endoscopic adhesiolysis, epidural injections of steroids, local anesthetics, hypertonic saline solutions, and revision surgery for the underlying disease.\u003csup\u003e14\u003c/sup\u003e Although those treatments can alleviate some symptoms, the long-term efficacy remains controversial, and patients have a low acceptance of invasive treatment methods.\u003c/p\u003e \u003cp\u003eGabapentin is a drug approved in China for the adjuvant treatment of partial seizures and postherpetic neuralgia. It has also been approved in Europe against diabetic peripheral neuropathic pain. The off-label use of gabapentin for various pain conditions is becoming increasingly common despite its analgesic effects.\u003csup\u003e15\u003c/sup\u003e As a structural analog of gamma-aminobutyric acid (GABA), gabapentin is in an inactive state and only becomes active by binding to the α2δ subunit of the presynaptic membrane calcium channel, thereby suppressing the influx of calcium ions and reducing the release of pain-causing substances. Gabapentin can also inhibit the activity of N-methyl-D-aspartate (NMDA) receptors, reducing the influx of Ca\u003csup\u003e2+\u003c/sup\u003e and Na\u003csup\u003e+\u003c/sup\u003e as well as the efflux of K\u003csup\u003e+\u003c/sup\u003e, thereby reducing the abnormal neuronal firing induced by high calcium conductance and the resulting seizures and neuropathic pain.\u003csup\u003e16\u0026ndash;18\u003c/sup\u003e The specific mechanisms by which gabapentin causes abuse are unclear; however, they may be associated with GABA receptor mediation. Other GABA receptor-modulating drugs also prone to abuse include alcohol, benzodiazepines, and sleeping pills.\u003csup\u003e15\u003c/sup\u003e Regardless of whether they are used alone or combined with other medications, gabapentin can yield satisfactory therapeutic effects in the treatment of lower back pain; this is consistent with the present study findings.\u003csup\u003e19,20\u003c/sup\u003e Additionally, other studies have indicated that gabapentin does not alleviate lower back pain symptoms and increases adverse reactions including dizziness, headache, nausea, as well as impaired consciousness. Therefore, this study sought to identify a novel, economical, and safe alternative therapy to oral medication for treating PLSS.\u003c/p\u003e \u003cp\u003eThis study compared the efficacy of oral gabapentin and HILT in treating postoperative lumbar pain syndrome. As a novel and green, economical physical therapy, HILT has increasingly been used in the fields of orthopedic disorders and sports medicine with early success. However, additional research is necessary to determine its precise indications, working principles, and long-term efficacy. Laser is a special type of artificial light with medical therapeutic properties, including high intensity and directionality; it is primarily divided into HILT and low-level laser therapy (LLLT).\u003c/p\u003e \u003cp\u003eHILT is a non-invasive and painless treatment with a strong tissue penetration capacity (5 to 15 cm), that can act on deep human tissues and produce numerous photons to achieve multiple physical therapeutic effects. High-energy lasers penetrate deeper tissues at the same time reducing heat accumulation and preventing local tissue damage. The analgesic effect of HILT is based on multiple mechanisms of action, such as its capacity to reduce the production of pain substances, slow down the transmission of pain stimuli, and increase the production of morphine-like substances in the body (including β-EP).\u003csup\u003e21,22\u003c/sup\u003e Noteworthy, 5-HT plays a regulatory role in pain in both the peripheral and central nervous systems; its levels can be increased by the inflammation levels in patients with lumbar disc herniation.\u003csup\u003e23\u003c/sup\u003e Moreover, 5-HT can increase the infiltration of intervertebral nerve roots by enriching the local complement components or chemokines, hence increasing pain. Studies have shown that high-intensity laser therapy can substantially reduce the release of substance P from sensory nerve endings in the body, thereby alleviating pain. Of note, substance P activates the neurokinin-1 receptor, hence mediating pain transmission and producing hyperalgesia.\u003csup\u003e24,25\u003c/sup\u003e In addition, it can suppress the conduction of Aδ and C fibers, reduce the rate of neural conduction, and simultaneously disrupt neuro electrophysiological parameters, resulting in specific neural conduction blocks in nociceptors, and suppression of pain signal transmission.\u003csup\u003e26\u003c/sup\u003e HILT reduces bradykinin synthesis and the release of acetylcholine as well as histamine in damaged tissues through nerve fiber conduction block, hence increasing pain threshold of patients and alleviating pain.\u003csup\u003e25,27\u003c/sup\u003e The thermal effect produced by lasers can trigger local vasodilation, promoting rapid exchange and absorption of tissue oxygen as well as local metabolic products, allowing more oxygen into cells, participating in mitochondrial oxidative reactions, and accelerating ATP synthesis.\u003csup\u003e5,28\u003c/sup\u003e Several ATP molecules are used to synthesize cellular genetic material, promoting tissue repair and regeneration, at the same time also alleviating local edema.\u003csup\u003e29\u003c/sup\u003e The photochemical and photothermal effects of HILT can stimulate collagen production, and increase blood flow, vascular permeability, and cellular metabolism hence contributing to the repair of damaged tissues and eliminating painful stimuli.\u003csup\u003e30,31\u003c/sup\u003eAdditionally, when the skin of a patient comes into contact with the laser, there is a generation of a special photo-pressure in the human tissue, which can suppress the release of pain-causing substances from nerves, thereby relieving pain. Herein, we found that both HILT and oral gabapentin can reduce the levels of 5-HT and SP in the body, at the same time increasing the levels of β-EP, corroborating the aforementioned research findings.\u003c/p\u003e \u003cp\u003eFurthermore, the findings revealed that the VAS scores at the 1-month, 3-month, and 6-month follow-ups after treatment in the HILT group were significantly lower than those in the oral medication group. The ODI scores at 1 week, 1 month, and 12 months were also significantly lower than that in the oral medication group; this shows that high-intensity laser treatment can significantly relieve pain and improve the quality of life in patients with PLSS, with a greater degree of relief. Ozkaraoglu et al. randomly divided patients with lower back pain into a HILT group and a Transcutaneous Electrical Nerve Stimulation (TENS) group, both of which were subjected to exercise training, ultrasound, and heat therapy. \u003csup\u003e32\u003c/sup\u003e The results revealed that the degree of pain reduction in the HILT group was superior to that in the TENS group. Elsewhere, Choi et al. showed that patients with chronic back pain who received both HILT and exercise treatment experienced greater pain reduction than those who only underwent exercise therapy alone.\u003csup\u003e31\u003c/sup\u003e The same study did not however investigate the impact of HILT alone on pain improvement in patients, a research gap addressed by the present study. Our findings showed a delayed effect of high-intensity laser therapy, primarily due to the weak immediate analgesic effect of high-intensity laser on tissue. We noted that the long-term efficacy majorly relies on its tissue repair effect.\u003c/p\u003e \u003cp\u003eWe further conducted a quantitative statistical analysis of fat infiltration in the paraspinal muscles of the lumbar spine and discovered that HILT can significantly delay fat infiltration of paraspinal muscles. Muscle fat infiltration (MFI) is fat accumulation in the intermuscular and intramuscular adipose tissue or the form of lipid droplets within muscle cells. The paraspinal muscles of the lumbar spine primarily comprise the erector spinae and multifidus muscles, with the multifidus being a key muscle in preserving the stability of the lumbar spine. Paravertebral muscle fat infiltration (PMFI) is closely associated with lower back pain, decreased muscle strength, and endurance, which can reduce the capacity of the lumbar spine to maintain its tension. This can also decrease the capacity of paraspinal muscles to control external loads, becoming one of the important reasons prompting patients with PLSS to seek medical attention.\u003csup\u003e33,34\u003c/sup\u003e Fat infiltration is responsible for muscle damage, insulin resistance, and muscle dystrophy; it is also accompanied by a decline in muscle function.\u003csup\u003e35\u003c/sup\u003e Current research indicates that muscle fat infiltration causes an imbalance of muscle homeostasis. Skeletal muscles are inevitably damaged during lumbar spine surgery, causing an imbalance in skeletal muscle homeostasis. Endothelial cells, fibroadipogenic progenitors (FAPs), immune cells, pericytes, tendon cells, and nerve-related cells interact with each other, promoting muscle fat infiltration.\u003csup\u003e36\u003c/sup\u003e Additional studies have shown that patients with an FI of 25% or more have a significantly higher rate of spinal fusion failure than those with an FI of less than 25%. Severe PMFI may be a potential risk factor for spinal fusion failure.\u003csup\u003e37\u003c/sup\u003e After lumbar spine surgery, delaying paraspinal muscle fat infiltration is thus one of the important factors contributing to improved quality of life and reducing long-term postoperative complications. Studies on paraspinal muscle fat infiltration are limited, and there is no definitive treatment plan. Although HILT cannot reverse paraspinal muscle fat infiltration, we found that it can slow the process of muscle degeneration and can be future research directions on paraspinal muscle degeneration. This is because: (1) HILT can accelerate metabolism of paraspinal skeletal muscle cells, quickly clear metabolic toxins, promote the recovery of cellular and organelle functions, and delay cellular degeneration; (2) HILT can reduce the release of inflammatory mediators, resulting in less cellular degeneration; (3) HILT can promote collagen synthesis and fibrotic processes, accelerating the repair and regeneration of fibrous tissues; (4) After relieving pain, HILT allows the recovery of paraspinal muscle activation in daily life, thereby increasing muscle cell contraction and slowing down muscle degeneration.\u003c/p\u003e\u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study has limitations. First, regarding the single-blind study, the outcome assessor and the physical therapists who provided treatment knew the treatment group allocation, which might cause study bias. Secondly, the sample size in this study is relatively small, which may bring potential biases in the results. Thirdly, we did not investigate the optimal dosage for high-energy laser irradiation treatment. Therefore, future studies should include more patients and carry out randomized controlled trials with different high-energy laser dosage treatment groups to explore the optimal dosage of this therapy; this would promote the standardized use of high-energy laser irradiation in clinical practice. Moreover, future research should further explore molecular biological mechanisms by which high-energy lasers delay paraspinal muscle degeneration.\u003c/p\u003e "},{"header":"5. Conclusion","content":"\u003cp\u003eIn conclusion, we explored the efficacy of high-intensity laser irradiation in the treatment of patients with PLSS. Among PLSS patients, we unraveled that HILT can significantly improve clinical symptoms, outperforming oral gabapentin in delaying the long-term degeneration of paraspinal muscles post-surgery. We anticipate that HILT will potentially replace oral medications as a treatment against PLSS.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eR.Z. Zhao: Writing \u0026ndash; original draft, Project administration.J.J. Qiao: Methodology, Investigation, Formal analysis, Data curation, Conceptualization.X.Y. Lv: Writing \u0026ndash; original draft.Xiutong Fang: Visualization, Supervision, Project administration, Conceptualization.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eManchikanti, L., Manchikanti, K.N., Gharibo, C.G., and Kaye, A.D. (2016). Efficacy of Percutaneous Adhesiolysis in the Treatment of Lumbar Post Surgery Syndrome. 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J Orthop Surg Res \u003cem\u003e17\u003c/em\u003e, 289. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13018-022-03186-2\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Post Lumbar Surgery Syndrome, Gabapentin, High-Intensity Laser Therapy, Paraspinal Muscle Fat Infiltration","lastPublishedDoi":"10.21203/rs.3.rs-5770330/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5770330/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to investigate the efficacy of high-intensity laser treatment against post-lumbar surgery syndrome (PLSS) through a randomized controlled trial.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003e PLSS admitted at our hospital between 2020 and 2022 were recruited and randomly divided into two groups, i.e., the oral medication group (Group A) and the high-intensity laser therapy group (Group B). We analyzed the visual analog scale (VAS) and Oswestry Disability Index (ODI) of both groups. We also analyzed serum pain indicators and the extent of paraspinal muscle fat infiltration before and after treatment, at one week, one month, three months, six months, and twelve months post-treatment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter one month, three months, and six months post-treatment, VAS scores of Group B were significantly lower than those of Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After one week, one month, and twelve months post-treatment, the ODI of Group B was significantly lower than that of Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). One month after treatment, Group B patients had significantly lower levels of 5-HT and substance P (SP) than Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The content of β-endorphins (β-EP) in the blood of Group B was higher than that of Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018). The progression of paraspinal muscle fat infiltration in Group B was significantly slower than that in Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHILT can improve the clinical symptoms of patients with PLSS, delay the degenerative changes in the paraspinal muscles of the lumbar spine, and improve the long-term postoperative quality of life of patients.\u003c/p\u003e","manuscriptTitle":"Efficacy Analysis of High-Intensity Laser Therapy for Post Lumbar Surgery Syndrome: A Randomized Controlled Trial Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-08 20:06:51","doi":"10.21203/rs.3.rs-5770330/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d98b24d6-0bed-426d-9bdb-373c352a890b","owner":[],"postedDate":"January 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-16T01:38:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-08 20:06:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5770330","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5770330","identity":"rs-5770330","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}