407: Injury to the facet joints is associated with postoperative pain following lumbar endoscopic surgery

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Gender/sex differences, Imaging (e.g. fMRI, PET, MRS)

Background and Aims: Percutaneous transforaminal endoscopic discectomy (PTED) is a commonly used minimally invasive surgical procedure for the treatment of lumbar disc herniation, yet 87.9% of patients still complain of lumbogluteal pain after surgery, and its specific etiology remains unclear. This study aimed to systematically investigate the factors associated with post-operative lumbogluteal pain following PTED, with a focus on the impact of superior articular process resection and articular process injury during surgical manipulation on post-operative pain, so as to provide evidence for clinical precise treatment and rehabilitation management.

Methods: A total of 158 patients who underwent PTED from September 2024 to September 2025 were retrospectively enrolled. Variables including demographic characteristics, pre- and post-operative inflammatory markers, surgical parameters, Visual Analogue Scale (VAS) scores for pain, and Oswestry Disability Index (ODI) were collected. Three-dimensional imaging reconstruction was used to quantitatively calculate the percentage of bone resection of the superior articular process, and articular process injury was graded based on post-operative computed tomography (CT). Spearman correlation analysis, multiple linear regression, and subgroup analysis were adopted to explore the correlations between various factors and pain at different post-operative time points.

Results: Pre-operative pain severity, anxiety and depression, female gender, and the inflammatory marker of erythrocyte sedimentation rate (ESR) were positively correlated with early post-operative pain. Pain at 24 hours after surgery (VAS2) was significantly positively correlated with the bone resection volume of the superior articular process (r=0.488, P<0.01), and the bone resection volume was an independent predictor of it (B=0.026, P<0.001). Pain at 72 hours after surgery (VAS3) had the strongest correlation with the grade of articular process injury (r=0.427, P<0.01), which also served as an independent predictor (B=0.920, P<0.001).

Conclusions: Post-operative lumbogluteal pain after PTED is jointly affected by surgical trauma, articular structural injury, systemic inflammatory state, and patients' psychophysiological characteristics, and the pain mechanism presents a dynamic evolution: early pain is mainly caused by direct surgical trauma, while late pain is more attributed to biomechanical changes induced by articular process injury. It is recommended to protect the integrity of the articular process as much as possible, and implement a comprehensive management strategy centered on surgical optimization, combined with multimodal analgesia and psychological intervention for high-risk patients.

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Presenting Author: Huacheng Zhou
Submitting Author: Tingting Yu

Senior Author: Huacheng Zhou

IASP 2026 Global Year theme of Neuropathic Pain: Yes