Association of glucose metabolism status and paraspinal muscle degeneration with chronic pain after endoscopic lumbar decompression: a multicentre retrospective study

Front Endocrinol (Lausanne). 2026 May 29;17:1867106. doi: 10.3389/fendo.2026.1867106. eCollection 2026.

ABSTRACT

OBJECTIVE: To investigate the associations of glucose metabolism status and paraspinal muscle degeneration with chronic low back pain (CLBP) after endoscopic lumbar decompression, and to evaluate the clinical significance of metabolic abnormalities, paraspinal muscle fat infiltration, and psoas muscle reserve in persistent postoperative pain.

METHODS: A total of 1,076 patients with lumbar disc herniation (LDH) who underwent unilateral biportal endoscopic (UBE) decompression at three medical centres between January 2021, and December 2024 were retrospectively included. Based on follow-up outcomes, patients were classified into CLBP and non-CLBP groups. Preoperative imaging parameters included multifidus fatty infiltration (MF FI), erector spinae fatty infiltration (ES FI), and the psoas muscle index (PMI). Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with postoperative CLBP. Restricted cubic spline (RCS) analysis was used to assess potential nonlinear associations between key variables and postoperative CLBP risk.

RESULTS: Postoperative CLBP developed in 328 patients. Compared with patients in the non-CLBP group, those in the CLBP group were older, had higher HbA1c levels, and had lower PMI values. MF FI and ES FI were also higher in the CLBP group (both P < 0.001). Multivariable logistic regression analysis showed that age (OR = 1.07), HbA1c (OR = 1.16), MF FI (OR = 1.10), and ES FI (OR = 1.13) were independently associated with an increased risk of postoperative CLBP, whereas PMI was protective (OR = 0.71; all P < 0.001). RCS analysis indicated nonlinear associations of HbA1c, age, and MF FI with postoperative CLBP risk, whereas ES FI and PMI showed approximately linear associations.

CONCLUSION: The risk of CLBP after endoscopic lumbar decompression was associated not only with local decompression but also with preoperative glucose metabolism status, paraspinal muscle fat infiltration, and overall muscle reserve. Metabolic abnormalities, degeneration of the local stabilising system, and reduced muscle reserve may collectively contribute to persistent postoperative pain.

PMID:42290878 | PMC:PMC13259684 | DOI:10.3389/fendo.2026.1867106