Lumbar stiffness complaints, stiffness-related disability, and low back pain in relation to patient satisfaction: a cross-sectional analysis across different postoperative stages

A retrospective cross-sectional study. To investigate postoperative lumbar stiffness complaints across surgical groups and to examine the associations of stiffness-related disability and low back pain with patient satisfaction after lumbar surgery. A total of 410 patients who underwent lumbar surgery for degenerative lumbar disease were categorized into three surgical groups: minimally invasive non-fusion surgery, short-segment fusion, and long-segment fusion. Patients were further stratified by postoperative stage at assessment (6 months, 1 year, and ≥ 2 years). Current lumbar stiffness complaints were analyzed in 301 patients. Patient-reported measurements including Visual analog scale (VAS), Oswestry Disability Index (ODI), and Lumbar Stiffness Disability Index (LSDI) were compared using nonparametric tests with multiplicity correction. Patient-reported satisfaction was rated on a 5-point ordinal scale ranging from 1 (very satisfied) to 5 (very unsatisfied), with higher scores indicating poorer satisfaction. Associations with satisfaction were evaluated using Holm-adjusted Spearman correlations and an adjusted proportional-odds model; surgical-group-by-stage interactions were also examined. Stiffness complaints were common among available responses, but their proportions did not differ significantly among surgical groups at 6 months ( P = 0.824), 1 year ( P = 0.287), or ≥ 2 years ( P = 0.174). Cross-sectional outcome distributions differed by surgical group and stage. After Holm correction, LSDI was associated with poorer satisfaction at all three stages in the long-segment group (adjusted P = 0.012, 0.012, and 0.018), whereas VAS-LBP was not significant at 1 year or ≥ 2 years. In the proportional-odds model, higher VAS-LBP (adjusted odds ratio [aOR] = 1.36), LSDI (aOR = 1.53), and ODI (aOR = 2.71) were each independently associated with poorer satisfaction. Group-by-stage interactions were significant for LSDI and ODI, but not VAS-LBP. Postoperative lumbar stiffness is a clinically relevant patient-reported complaint after lumbar surgery, particularly in long-segment fusion. LSDI provided information distinct from residual low back pain and was independently associated with poorer satisfaction; however, the cross-sectional design and differential missingness of the complaint variable preclude longitudinal or causal inference.