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

While spinopelvic fixation effectively restores alignment in traumatic injuries, long-term patient-centered outcomes, particularly chronic pain, are poorly characterized. This study aimed to evaluate one-year multidimensional outcomes, with a focused analysis on the prevalence and predictors of chronic pain following this surgery. A prospective cohort study was conducted at two trauma centers. Forty-five consecutive adult patients with traumatic spinopelvic instability undergoing fixation were enrolled. Outcomes included the Majeed Pelvic Score (MPS), pain (VAS), function (SF-36 PF, Barthel Index), and radiographic alignment. Chronic pain (VAS>4 for ≥2 months beyond 3 months post-op) was a primary focus. Regression analysis was performed to identify predictors of chronic pain. Assessments occurred preoperatively and at 2 weeks, 1, 3, 6, and 12 months. The cohort (mean age 41.9±13.5; 73.3% male) showed significant improvement in MPS (from 35.0±8.2 to 84.0±7.1 at one year, p<0.001) and radiographic parameters (p<0.001). Despite an overall reduction in mean VAS, chronic pain was prevalent in 77.8% (n=35). In multivariate logistic regression, independent predictors of chronic pain at one year included higher preoperative VAS (OR=1.8, 95%CI 1.2-2.7, p=0.004), the presence of neurological injury at presentation (OR=4.3, 95%CI 1.1-16.9, p=0.037), and less optimal postoperative radiographic reduction (vertical displacement >5mm) (OR=3.5, 95%CI 1.2-10.1, p=0.021). The complication rate was 20%. Spinopelvic fixation leads to excellent functional and radiographic outcomes. However, chronic pain remains a highly prevalent and distinct challenge. We identified preoperative pain intensity, neurological injury, and suboptimal reduction as key predictors. These findings argue for a stratified postoperative approach, integrating advanced pain management and neurological rehabilitation from the outset for high-risk patients, beyond achieving anatomical success alone. III ( prognostic study).