Impact of Preoperative Nutritional Status on Residual Neuropathic Pain After Cervical Laminoplasty in Geriatric Patients

Study Design: Retrospective cohort study. Objective: To investigate the association between preoperative nutritional status and postoperative residual neuropathic pain (NeP) in geriatric patients undergoing cervical laminoplasty. Background: NeP frequently persists after cervical spine surgery and adversely affects postoperative recovery. Although several clinical factors have been examined, the role of preoperative nutritional status in the persistence of postoperative NeP remains unclear. Materials and Methods: We reviewed 119 patients aged 65 years or older who underwent cervical laminoplasty. NeP was assessed using the painDETECT questionnaire (PDQ), with NeP defined as a PDQ score ≥13. Residual NeP was defined as the persistence of NeP at two years postoperatively. Nutritional status was evaluated using the geriatric nutritional risk index (GNRI), and malnutrition was defined as GNRI ≤98 and stratified by GNRI-based grading. Clinical outcomes, including PDQ scores and pain numerical rating scale (NRS), were compared according to nutritional status. Multivariable logistic regression analysis was performed to identify independent predictors for residual NeP. Results: Residual NeP at two years postoperatively was observed in 25% of the cohort. Its prevalence increased in a stepwise manner according to preoperative nutritional status, from 15% in patients with normal nutrition to 50% and 57% in those with mild and moderate nutritional risk, respectively ( P <0.001). Parallel trends were observed for pain-related outcomes: mean PDQ scores at two years increased (6.7, 12.5, and 12.9; P <0.001), whereas the proportion of pain-NRS 50% responders decreased (79%, 33%, and 36%; P <0.001) across the same nutritional grading. Preoperative nutritional risk (GNRI-grade) was independently associated with residual NeP odds ratio (OR): 5.0; 95% CI: 1.6–15.5; P =0.005, as was a higher preoperative PDQ score (OR: 1.2; 95% CI: 1.1–1.4; P <0.001). Conclusions: Preoperative nutritional status is closely associated with residual NeP after cervical laminoplasty, with increasing nutritional risk conferring a higher likelihood of postoperative pain persistence. Level of Evidence: Level IV.