Abstract
PURPOSE: To comprehensively investigate multifactorial influences on postoperative pain in patients with degenerative lumbar spine disease undergoing posterior lumbar interbody fusion (PLIF), thereby guiding targeted rehabilitation. PATIENTS AND METHODS: We reviewed 316 patients (age >40) who underwent PLIF from January 2022 to May 2024. Based on postoperative Numeric Rating Scale (NRS) scores and pain duration, they were divided into a non-pain group (210 cases) and a pain group (106 cases). We assessed paraspinal muscle indices (PMI, MMI), Self-Rating Anxiety Scale (SAS), postoperative exercise duration, surgical segments, drainage removal time, and mannitol usage. Univariate and multivariate logistic regression analyses were conducted. RESULTS: No significant differences were found in age, BMI, education, surgical duration, drainage time, disease duration, time to first ambulation, or mannitol usage (P > 0.05). However, gender, SAS scores, surgical segments, drainage volume at removal, PMI, MMI, average standing time in the first 2 weeks, and duration of straight-leg raise exercises differed significantly (P < 0.05). Multivariate analysis identified surgical segment (P = 0.008), drainage volume at removal (P = 0.008), MMI (P < 0.001), average standing time (P = 0.010), and straight-leg raise exercise duration (P = 0.012) as independent risk factors. CONCLUSION: Paraspinal muscle health and early postoperative exercise are crucial factors influencing PLIF-related postoperative pain. Tailored rehabilitation, enhanced muscle function, and optimized early exercise may reduce postoperative pain and improve outcomes.