Original Article|Articles in Press

Sensory Symptoms and effects on Health-related Quality of Life of Patients Undergoing Lumbar Spine Surgery

Published:November 14, 2022DOI:



      Patients with lumbar degenerative spine diseases (LDSDs) commonly report sensory symptoms before and after lumbar spine surgery.


      To explore the changing patterns of sensory symptoms—namely pain, numbness, stinging, itching, and burning—and investigate the influences of sensory symptom changes on the health-related quality of life (HRQoL) of patients who experienced lumbar spine surgery.


      All sensory symptoms (i.e., pain, numbness, paresthesia) were measured using a visual analog scale. The Chinese versions of the Oswestry Disability Index, Pittsburgh Sleep Quality Index, Clinically Useful Depression Outcome Scale, and EuroQol-five dimensions (EQ-5D) Scale were used to assess patients 1 week prior to surgery and 6 weeks and 6 months after surgery. A generalized estimating equation was used for data analysis.


      A total of 101 patients with mean age of 58.38 years were included. All sensory symptoms declined significantly over time (all p < .05) with the exception of itching (feeling on toes and thighs). Patients experiencing moderate-to-severe pain had poorer QoL over time, even after controlling for other sensory symptoms and potential confounders.


      Sensory symptoms gradually declined after surgery, but itching symptom did not. Moderate-to-severe pain was the only sensory symptom that influenced HRQoL over time in patients with LDSDs.
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        • Agnus Tom A.
        • Rajkumar E.
        • John R.
        • Joshua George A.
        Determinants of quality of life in individuals with chronic low back pain: a systematic review.
        Health Psychology and Behavioral Medicine. 2022; 10: 124-144
        • Ahmed H.
        • Kishore K.
        • Bhat P.
        • Alghadir A.H.
        • Iqbal A.
        Impact of work-related chronic low back pain on functional performance and physical capabilities in women and men: a sex-wise comparative study.
        BioMed Research International. 2022; 20226307349
        • Alvin M.D.
        • Miller J.A.
        • Lubelski D.
        • Nowacki A.S.
        • Scheman J.
        • Mathews M.
        • McGirt M.J.
        • Benzel E.C.
        • Mroz T.E.
        The impact of preoperative depression and health state on quality-of-life outcomes after anterior cervical diskectomy and fusion.
        Global Spine Journal. 2016; 6: 306-313
        • Boonstra A.M.
        • Schiphorst Preuper H.R.
        • Balk G.A.
        • Stewart R.E.
        Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain.
        Pain. 2014; 155: 2545-2550
        • Brooks R.
        EuroQol: The current state of play.
        Health Policy. 1996; 37: 53-72
        • Buysse D.J.
        • Reynolds 3rd, C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J.
        The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
        Psychiatry Research. 1989; 28: 193-213
        • Chang T.J.
        • Tarn Y.H.
        • Hsieh C.L.
        • Liou W.S.
        • Shaw J.W.
        • Chiou X.G.
        Taiwanese version of the EQ-5D: validation in a representative sample of the Taiwanese population.
        Journal of the Formosan Medical Association. 2007; 106: 1023-1031
        • Chapman J.R.
        • Norvell D.C.
        • Hermsmeyer J.T.
        • Bransford R.J.
        • DeVine J.
        • McGirt M.J.
        • Lee M.J.
        Evaluating common outcomes for measuring treatment success for chronic low back pain.
        Spine (Phila Pa 1976). 2011; 36: S54-S68
        • EuroQol Group
        EuroQol–a new facility for the measurement of health-related quality of life.
        Health Policy. 1990; 16: 199-208
      1. EuroQol Foundation. (2018). EQ-5D-3L User Guide: Basic information on how to use the EQ-5D-3L instrument. Retrieved March, 2022, from

        • Fairbank J.C.
        • Couper J.
        • Davies J.B.
        • O'Brien J.P
        The Oswestry low back pain disability questionnaire.
        Physiotherapy. 1980; 66: 271-273
        • Gautschi O.P.
        • Smoll N.R.
        • Corniola M.V.
        • Joswig H.
        • Schaller K.
        • Hildebrandt G.
        • Stienen M.N.
        Sex differences in lumbar degenerative disc disease.
        Clinical Neurology and Neurosurgery. 2016; 145: 52-57
        • Gautschi O.P.
        • Smoll N.R.
        • Joswig H.
        • Corniola M.V.
        • Schaller K.
        • Hildebrandt G.
        • Stienen M.N.
        Influence of age on pain intensity, functional impairment and health-related quality of life before and after surgery for lumbar degenerative disc disease.
        Clinical Neurology and Neurosurgery. 2016; 150: 33-39
        • Goh K.J.
        • Khalifa W.
        • Anslow P.
        • Cadoux-Hudson T.
        • Donaghy M.
        The clinical syndrome associated with lumbar spinal stenosis.
        European Neurology. 2004; 52: 242-249
        • Haywood K.L.
        • Garratt A.M.
        • Dziedzic K.
        • Dawes P.T.
        Generic measures of health-related quality of life in ankylosing spondylitis: reliability, validity and responsiveness.
        Rheumatology (Oxford). 2002; 41: 1380-1387
        • Hedeker D.
        • Gibbons R.D.
        • Waternaux C.
        Sample size estimation for longitudinal designs with attrition: comparing time-related contrasts between two groups.
        Journal of Educational and Behavioral Statistics. 1999; 24: 70-93
        • Heider D.
        • Kitze K.
        • Zieger M.
        • Riedel-Heller S.G.
        • Angermeyer M.C.
        Health-related quality of life in patients after lumbar disc surgery: a longitudinal observational study.
        Quality of Life Research. 2007; 16: 1453-1460
        • Hsu L.F.
        • Kao C.C.
        • Wang M.Y.
        • Chang C.J.
        • Tsai P.S.
        Psychometric testing of a Mandarin Chinese Version of the Clinically Useful Depression Outcome Scale for patients diagnosed with type 2 diabetes mellitus.
        International Journal of Nursing Studies. 2014; 51: 1595-1604
        • Huang P.
        • Sengupta D.K.
        How fast pain, numbness, and paresthesia resolves after lumbar nerve root decompression: a retrospective study of patient's self-reported computerized pain drawing.
        Spine (Phila Pa 1976). 2014; 39: E529-E536
        • Jansson K.å.
        • Németh G.
        • Granath F.
        • Jönsson B.
        • Blomqvist P
        Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis.
        Journal of Bone and Joint Surgery. British volume. 2009; 91: 210-216
        • Lee H.Y.
        • Hung M.C.
        • Hu F.C.
        • Chang Y.Y.
        • Hsieh C.L.
        • Wang J.D.
        Estimating quality weights for EQ-5D (EuroQol-5 dimensions) health states with the time trade-off method in Taiwan.
        Journal of the Formosan Medical Association. 2013; 112: 699-706
        • Lin J.H.
        • Hung C.H.
        • Han D.S.
        • Chen S.T.
        • Lee C.H.
        • Sun W.Z.
        • Chen C.C.
        Sensing acidosis: nociception or sngception?.
        Journal of Biomedical Science. 2018; 25: 85
        • Lubelski D.
        • Thompson N.R.
        • Bansal S.
        • Mroz T.E.
        • Mazanec D.J.
        • Benzel E.C.
        • Khalaf T.
        Depression as a predictor of worse quality of life outcomes following nonoperative treatment for lumbar stenosis.
        Journal Neurosurgey Spine. 2015; 22: 267-272
        • Lue Y.J.
        • Hsieh C.L.
        • Huang M.H.
        • Lin G.T.
        • Lu Y.M.
        Development of a Chinese version of the Oswestry Disability Index version 2.1.
        Spine (Phila Pa 1976). 2008; 33: 2354-2360
        • Nassar N.
        • Assaf N.
        • Farrag D.
        • Ibrahim D.
        • Al-Sheekh A
        Depression in patients with chronic low back pain.
        Egyptian Rheumatology and Rehabilitation. 2019; 46: 48-54
        • Oba H.
        • Takahashi J.
        • Tsutsumimoto T.
        • Ikegami S.
        • Ohta H.
        • Yui M.
        • Kosaku H.
        • Kamanaka T.
        • Misawa H.
        • Kato H.
        Predictors of improvement in low back pain after lumbar decompression surgery: Prospective study of 140 patients.
        Journal of Orthopaedic Science. 2017; 22: 641-646
        • Oba H.
        • Tsutsumimoto T.
        • Yui M.
        • Kamanaka T.
        • Ohta H.
        • Kosaku H.
        • Misawa H.
        A prospective study of recovery from leg numbness following decompression surgery for lumbar spinal stenosis.
        Journal of Orthopaedic Science. 2017; 22: 670-675
        • Ondeck N.T.
        • Bohl D.D.
        • Bovonratwet P.
        • McLynn R.P.
        • Cui J.J.
        • Shultz B.N.
        • Lukasiewicz A.M.
        • Grauer J.N.
        Discriminative ability of commonly used indices to predict adverse outcomes after poster lumbar fusion: a comparison of demographics, ASA, the modified Charlson Comorbidity Index, and the modified Frailty Index.
        Spine Journal. 2018; 18: 44-52
        • Ravindra V.M.
        • Senglaub S.S.
        • Rattani A.
        • Dewan M.C.
        • Hartl R.
        • Bisson E.
        • Park K.B.
        • Shrime M.G.
        Degenerative lumbar spine disease: estimating global incidence and worldwide volume.
        Global Spine Journal. 2018; 8: 784-794
        • Sato J.
        • Ohtori S.
        • Orita S.
        • Yamauchi K.
        • Eguchi Y.
        • Ochiai N.
        • Kuniyoshi K.
        • Aoki Y.
        • Nakamura J.
        • Miyagi M.
        • Suzuki M.
        • Kubota G.
        • Inage K.
        • Sainoh T.
        • Fujimoto K.
        • Shiga Y.
        • Abe K.
        • Kanamoto H.
        • Inoue G.
        • Takahashi K.
        Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spondylolisthesis.
        European Spine Journal. 2017; 26: 671-678
        • Shaw J.W.
        • Johnson J.A.
        • Coons S.J.
        US valuation of the EQ-5D health states: development and testing of the D1 valuation model.
        Medical Care. 2005; 43: 203-220
        • Shen C.W.
        • Chen Y.H.
        Model selection of generalized estimating equations with multiply imputed longitudinal data.
        Biometrical Journal. 2013; 55: 899-911
        • Sigmundsson F.G.
        • Kang X.P.
        • Jonsson B.
        • Stromqvist B.
        Prognostic factors in lumbar spinal stenosis surgery.
        Acta Orthopaedica. 2012; 83: 536-542
        • Stienen M.N.
        • Joswig H.
        • Smoll N.R.
        • Corniola M.V.
        • Schaller K.
        • Hildebrandt G.
        • Gautschi O.P.
        Influence of body mass index on subjective and objective measures of pain, functional impairment, and health-related quality of life in lumbar degenerative disc disease.
        World Neurosurgery. 2016; 96 (e571): 570-577
        • Toyone T.
        • Tanaka T.
        • Kato D.
        • Kaneyama R.
        • Otsuka M.
        Patients' expectations and satisfaction in lumbar spine surgery.
        Spine (Phila Pa 1976). 2005; 30: 2689-2694
        • Tsai P.S.
        • Wang S.Y.
        • Wang M.Y.
        • Su C.T.
        • Yang T.T.
        • Huang C.J.
        • Fang S.C.
        Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects.
        Quality of Life Research. 2005; 14: 1943-1952
        • Vrieze S.I.
        Model selection and psychological theory: a discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC).
        Psychological Methods. 2012; 17: 228-243
        • Zimmerman M.
        • Chelminski I.
        • McGlinchey J.B.
        • Posternak M.A.
        A clinically useful depression outcome scale.
        Comprehensive Psychiatry. 2008; 49: 131-140