Search Results (96)

Background and Objectives: Chronic low back pain (CLBP) is a prevalent condition that impairs quality of life, functionality, and work productivity. While most acute episodes of back pain resolve, 4–25% become chronic due to factors such as high pain intensity, psychological distress, and maladaptive behaviors. Nonspecific CLBP is best understood through the biopsychosocial model, encompassing biological, psychological, and social influences, including kinesiophobia. Management relies on physical activity, pain education, and psychological interventions, with therapist knowledge and attitudes affecting outcomes. This study aimed to assess the prevalence of CLBP among healthcare workers, examine their knowledge of pain neurophysiology, evaluate kinesiophobia, and explore how personal experience with CLBP influences their beliefs, attitudes, and interactions with patients. Materials and Methods: A cross-sectional observational study was conducted from January to May 2025 among healthcare professionals. A total of 50 participants completed an online questionnaire, of which 42 were valid and included in the analysis. The questionnaire collected demographic and professional data, determined the presence of CLBP, and included three standardized instruments: the Revised Neurophysiology of Pain Questionnaire (rNPQ) to assess knowledge of pain mechanisms, the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) to evaluate beliefs about pain and disability, and the Tampa Scale of Kinesiophobia (TSK-11) to measure fear of movement. Data were analyzed using SPSS and Microsoft Excel. Results: Among the 42 participants, 11 demonstrated low, 28 moderate, and 3 high knowledge of pain neurophysiology (rNPQ), with a mean score of 5.66. On the HC-PAIRS, the majority (30 participants) scored above 60, indicating beliefs that pain leads to disability, while 12 scored below 60, reflecting a biopsychosocial perspective; gender did not significantly affect HC-PAIRS scores (p = 0.213). As for kinesiophobia (TSK-11), 24 participants had low, 17 moderate, and 1 clinically significant fear of movement. Correlation analysis revealed that younger participants had higher rNPQ scores (r = −0.358, p = 0.020) and lower TSK-11 scores (r = −0.389, p = 0.011). TSK-11 scores increased with age (r = 0.432, p = 0.004), while HC-PAIRS scores showed no significant correlations. Conclusions: Healthcare professionals, particularly physiotherapists, show gaps in knowledge of pain neurophysiology and a tendency toward biomedical beliefs regarding chronic low back pain. This cross-sectional study indicates that a greater understanding of pain mechanisms is associated with lower kinesiophobia, emphasizing the importance of education. Integrating the biopsychosocial model into undergraduate and continuing professional training, through interdisciplinary and practical modules, may improve knowledge, reduce maladaptive fear-avoidance behaviors, and enhance patient care. Future studies should include larger, more diverse samples and assess the long-term impact of educational interventions on clinical practice. Full article

Background/Objectives: Low back pain (LBP) is the leading cause of disability in Saudi Arabia and contributes substantially to healthcare utilisation, reduced quality of life, and lost productivity. This guideline provides nationally standardised, evidence-based recommendations for the assessment and management of non-specific LBP and sciatica in adults, adapted to the clinical and health-system context in Saudi Arabia. Methods: A multidisciplinary Task Force developed the guideline using the GRADE ADOLOPMENT approach, using NICE guideline NG59 as the primary evidence source. One additional clinical question was formulated to address pain neuroscience education, informed by a relevant systematic review. Update literature searches were conducted in PubMed, Embase, and the Cochrane Library (2016–2022). The evidence was appraised using GRADE, and recommendations were formulated through structured Evidence-to-Decision deliberations and consensus voting. Results: The Task Force addressed eleven clinical questions in this guideline. Strong recommendations were provided for the use of validated risk assessment tools (very low certainty of evidence) and stratified management (moderate certainty of evidence). Conditional recommendations were made for indications for imaging, pharmacological treatment for sciatica, psychological interventions, multidisciplinary return to work programmes, epidural injections, prognostic value of image-concordant pathology, spinal decompression, radiofrequency denervation, and pain neuroscience education, with certainty of evidence ranging from very low to low. Conclusions: The findings indicate that management of non-specific LBP and sciatica in Saudi Arabia should be guided by clinical assessment, with restricted use of imaging, careful selection of pharmacological treatments, and appropriate use of psychological, multidisciplinary, and procedural interventions. Full article

Background: Chronic low back pain (cLBP) with kinesiophobia is difficult to treat, and traditional graded activity approaches often show limited adherence and short-term effects. Virtual reality (VR) may enhance treatment engagement by providing immersive game-based environments that encourage therapeutic movement. This randomized controlled trial aimed to examine the effects of VR interventions designed to promote lumbar spine flexion in individuals with cLBP and elevated movement-related fear. Methods: Participants were randomized to one of two nine-week VR game conditions that differed only in the amount of lumbar flexion required. Primary outcomes were changes in pain intensity and disability from baseline to one-week post-treatment. Secondary analyses examined lumbar flexion and expectations of pain/harm as potential mediators. Follow-up assessments were conducted at multiple time points through 48 weeks to assess maintenance of treatment gains. Results: Both VR groups showed significant and clinically meaningful reductions in pain and disability at post-treatment. Improvements were maintained throughout the 48-week follow-up period. Depression symptoms continued to improve during follow-up. Expectations of pain and harm decreased significantly during treatment and remained reduced, whereas objective lumbar flexion did not change appreciably over time. Mediator analyses indicated that improved expectations of pain/harm, rather than increased lumbar flexion, were more closely associated with treatment response. Conclusions: Immersive VR gaming produced sustained reductions in pain, disability, and movement-related fear in individuals with cLBP and kinesiophobia. Findings suggest that VR may enhance rehabilitation outcomes by modifying maladaptive expectations rather than altering lumbar motion. VR-based interventions represent a promising and engaging approach for long-term cLBP management. Full article

Background and Objectives: Chronic knee pain (cKP) affects approximately 25% of adults worldwide, with prevalence increasing over recent decades. While conventional treatments have clinical limitations, several types of electrical stimulation have been suggested to improve patients’ quality of life. The electrical stimulation literature contains inadequate patient-reported outcome measures (PROMs) data. Encouraging preliminary H-Wave^® device PROMs results for chronic neck, shoulder, and low back pain have previously been published. This PROMs study’s goal is to similarly assess the efficacy of H-Wave^® device stimulation (HWDS) in patients with differing knee disorders. Materials and Methods: This is an independent, retrospective, observational cohort study analyzing H-Wave^® PROMs data, prospectively and sequentially collected over 4 years. In total, 34,192 pain management patient final surveys were screened for participants who were at least 18 years old, used H-Wave^® for any knee-related disorder, reporting chronic pain from 90 to 730 days, with device treatment duration from 22 to 365 days. PROMs included effects on function, pain, sleep quality, need for medications, ability to work, and patient satisfaction; additional data includes gender, age (when injured), chronicity of pain, prior treatments, and frequency and length of device use. Results: PROMs surveys from 34,192 HWDS patients included 1143 with “all knee”, 985 “knee injury”, and 124 “knee degeneration” diagnoses. Reported improvements in function/ADL (96.51%) and work performance (84.63%) were significant (p < 0.0001), with ≥20% pain relief in 86.76% (p < 0.0001), improving 2.96 points (average 0–10 NRS). Medication use decreased (69.85%, p = 0.0008), while sleep improved (55.33%) in knee injury patients. Patient satisfaction measures exceeded 96% (p < 0.0001). Subgroup analysis suggests that longer device use and shorter pain chronicity resulted in increased (p < 0.0001) HWDS benefits. Conclusions: HWDS PROMs data analysis demonstrated similarly encouraging outcomes for cKP patients, as previously reported for several other body regions. Knee injury and degeneration subgroups had near-equivalent benefits, as observed for all knee conditions. Despite many reported methodological limitations, which limit causal inference and preclude broader recommendations, HWDS appears to potentially offer several benefits for refractory cKP patients, requiring further studies. Full article

Background/Objectives: Pediatric osteoporosis is a multifactorial condition characterized by impaired bone mineralization and increased fracture risk, particularly vertebral compression fractures. This study aims to evaluate the diverse etiology, diagnostic challenges, and treatment options for pediatric osteoporosis in a cohort of affected children. Methods: We reviewed eleven pediatric patients (aged 5–16 years) diagnosed with vertebral fractures and osteoporosis, who were hospitalized between 2020 and 2024 at the Department of Endocrinology and Metabolic Diseases at PMMH-RI in Lodz. Clinical evaluation included medical history, physical examination, biochemical markers of bone metabolism, and imaging techniques such as dual-energy X-ray absorptiometry (DXA) to determine underlying causes of bone fragility. Results: The cohort presented a broad etiological spectrum, including seven patients with genetic disorders (e.g., mutations in COL1A1, LRP5, SGMS2, and ALPL genes) and secondary osteoporosis due to chronic diseases requiring prolonged glucocorticoid therapy (two patients with Duchenne muscular dystrophy (DMD), one patient with Crohn’s disease) or endocrinological disorders (one patient with Cushing disease). Vertebral fractures were confirmed in all patients, with back pain as the predominant symptom. Low bone mass (BMD Z-score < −2.0) was observed in eight individuals; in others, clinical signs of skeletal fragility were present despite Z-scores above this threshold. Mild biochemical abnormalities included hypercalciuria (3/11 cases) and vitamin D deficiency (6/11 cases). Height adjustment improved BMD interpretation in short-stature patients. Most children received bisphosphonate therapy, supplemented with calcium and vitamin D. In two patients, bisphosphonates were not used due to lack of parental consent or underlying conditions in which such treatment is not recommended. Conclusions: Pediatric osteoporosis requires a multidisciplinary diagnostic and therapeutic approach, integrating clinical, biochemical, and genetic factors. It is a heterogeneous and often underrecognized condition, with vertebral fractures frequently serving as its earliest sign—even in the absence of overt symptoms or low bone mass. This underscores the need for clinical vigilance, as significant skeletal fragility may occur despite normal BMD values. Importantly, pediatric osteoporosis may also impact the attainment of peak bone mass and ultimately affect final adult height. Early diagnosis through thorough assessment, including height-adjusted DXA, and a multidisciplinary approach are essential to ensure timely management and prevent long-term complications. Full article

Recent scientific advances point towards an important role for oral and gastrointestinal health in people with chronic pain. Poor oral health (e.g., periodontitis, tooth loss) is observed in subgroups of the chronic pain population, including abdominal pain, low back pain, fibromyalgia, and rheumatoid arthritis. In addition to poor oral health, studies have also revealed altered intestinal microbiota compositions in various types of chronic pain, including people with chronic low back pain, knee osteoarthritis, visceral pain, fibromyalgia, tinnitus, and migraine. While overweight/obesity contributes to the likelihood of gut dysbiosis, normal-weight individuals with chronic pain also more often present with poor gut health. Both gastrointestinal and oral health problems (e.g., periodontitis, tooth loss) are increasingly recognized across multiple chronic pain conditions, including abdominal pain, low back pain, fibromyalgia, and rheumatoid arthritis. This perspective paper provides an overview of the requirements for integrating oral and gastrointestinal health in chronic pain management. First and foremost, oral and gastrointestinal health issues need to be recognized as common chronic pain comorbidities that require tailored treatment. Next to recognition of the issue, individuals seeking care for chronic pain need to be screened routinely for these oral and gastrointestinal comorbidities. In terms of management, the following options are suggested: (1) providing oral and gastrointestinal health science education; (2) considering the possible interplay between the gut microbiome and drug treatment (including polypharmacy); (3) expanding the importance of dietary interventions; and (4) considering the potential interplay with other lifestyle factors (e.g., chronic insomnia, overweight/obesity, depression and anxiety). To inform the implementation of these suggestions, longitudinal cohort studies investigating the role of oral and gastrointestinal health in people with chronic pain, as well as studies exploring possible (modifiable) factors that affect the oral and/or gut microbiome, are needed. This includes the bidirectional interplay between the gut microbiome and drugs commonly prescribed to patients with chronic pain. Likewise, adequately powered and controlled clinical trials evaluating the effectiveness of possible treatments for oral and/or gastrointestinal comorbidities in people with chronic pain represent another research priority. Such randomized clinical trials can not only examine the possible causal link between poor oral/gut health and treatment outcomes, but also inform the development of new, innovative ways to improve care for people with chronic pain. Full article

We report a rare case of isolated bilateral pedicle fractures in the lumbar spine that occurred without any identifiable risk factors. Such fractures are uncommon, as they are typically accompanied by multiple other fractures. This type of fracture is commonly associated with widely acknowledged predisposing factors, including high-energy trauma, degenerative spine disease, previous spinal surgery, stress-related activities, or osteoporosis. Additionally, some reports suggest these fractures can result from low-energy trauma when underlying conditions such as osteoporosis are present. This report describes a 43-year-old female who presented with gradually aggravating low back pain in the absence of any significant trauma history. Initially, she denied any preceding injury, considering the event too trivial to mention. However, upon detailed history taking, she later recalled minor contact with the edge of her bed two days prior to symptom onset. Conservative management, consisting of administration of painkillers, adequate rest, the use of a brace, and rehabilitation exercises, led to significant improvement, with marked relief of clinical symptoms and fracture healing observed in follow-up imaging. Early identification and appropriate management of isolated pedicle fractures are essential, as delayed diagnosis may lead to chronic pain or long-term sequelae. Furthermore, unilateral fracture can increase mechanical loading on the contralateral pedicle, making it vulnerable to secondary stress injury. Therefore, clinicians must remain alert to the possibility of isolated pedicle fractures even in patients without risk factors. Thorough history taking is also essential, as unrecognized minor trauma may hinder timely diagnosis and optimal outcomes. Full article

Chronic pain is a pervasive global health issue that significantly impairs quality of life and remains inadequately managed by current therapeutic options. Traditional pharmacological treatments often offer limited relief and are associated with significant side effects, highlighting the urgent need for safer and more effective alternatives. Among emerging strategies, mesenchymal stem cell (MSC)-derived secretome, an acellular product composed of bioactive molecules such as cytokines, growth factors and extracellular vesicles, has gained increasing attention for its potent anti-inflammatory, neuroprotective and immunomodulatory properties. Unlike whole-cell therapies, secretome-based interventions offer advantages, including lower immunogenicity, higher safety and easier standardization and storage. Preclinical studies demonstrated that MSC secretome effectively alleviates pain-like behavior across various models of neuropathic, inflammatory and degenerative pain, primarily through neuroimmune modulation and glial cell reprogramming. In vitro experiments confirm its role in promoting neuronal survival, regulating opioid receptor expression and modulating (neuro)inflammatory responses. Preliminary clinical evidence supports its analgesic efficacy in conditions such as osteoarthritis, chronic low back pain and post-surgical pain, with a favorable safety profile and promising therapeutic outcomes. However, challenges remain, including variabilities in secretome composition, lack of standardized production protocols and absence of large-scale clinical trials. Despite these limitations, MSC secretome therapy represents a transformative approach in pain medicine. Continued research efforts are essential to optimize formulation, dosing and delivery strategies, as well as to clarify the regulatory landscape. With further validation, the MSC secretome could emerge as a novel, scalable and clinically viable solution for the management of chronic pain, bridging critical gaps in current treatment paradigms. Full article

Background/Objectives: Sacroiliitis is a painful inflammatory disorder of the sacroiliac joint, estimated to account for up to 25% of chronic low back pain. Treatment options are often limited, and many patients continue to experience symptoms despite conservative or interventional management. High-Intensity Focused ultrasound (HIFU) has emerged as a novel noninvasive neuromodulation technique. However, the contribution of individual lumbosacral nerve branches (L5–S3) to pain generation during such interventions remains unclear. This study aimed to characterize the distribution of pain-related interruptions during HIFU procedures, with a particular focus on identifying the most pain-sensitive targets. Methods: Eight patients with clinically confirmed sacroiliitis underwent HIFU ablation targeting the L5–S3 branches. Procedural data, including the total number of sonications and interruptions due to pain, were prospectively recorded. Statistical analyses were performed using chi-square tests, including overall distribution testing, pairwise branch comparisons, and an aggregated comparison of S3 versus all other branches combined. Effect sizes were calculated using Cohen’s w. Results: Across 243 sonications, 162 interruptions (66.7%) occurred due to pain. Interruptions were unevenly distributed: 81% occurred at S2 and S3, with S3 alone accounting for 42%. S3 showed significantly more interruptions than L5 (p = 0.0022), S1 (p = 0.0150), S2 (p = 0.0055), and all other branches combined (p < 0.001; w = 0.58, large effect). S2 also demonstrated greater sensitivity than L5 (p = 0.003) and S1 (p = 0.001). Subdivision analysis revealed uniformly high sensitivity across S3, whereas S1 and S2 displayed heterogeneous patterns. Conclusions: HIFU stimulation revealed disproportionate pain sensitivity in sacral branches, with S3—and to a lesser extent S2—emerging as dominant contributors. These findings provide new insight into sacroiliitis pathophysiology and suggest prioritization of S3 in targeted interventional management. Full article

Objectives: Pilates is frequently recommended for patients with Chronic Nonspecific Low Back Pain (CNLBP) due to its potential to enhance posture, muscle strength, trunk flexibility, and stability. However, to date, there is no robust evidence supporting the effectiveness of Pilates in managing CNLBP. This study aimed to assess the effects of 8 × 8 Pilates Matwork core exercises on pain and functioning in middle-aged adult women with CNLBP, through a flexion relaxation phenomenon (FRP) analysis. Methods: We included middle adult women (n = 21) with diagnosis of CNLBP and a Numeric Rating Scale (NRS) > 4. The experimental group underwent a treatment of eight Pilates Matwork sessions, biweekly for 4 weeks, lasting about 40 min. The control group underwent standardized exercises used for managing CNLBP. Outcome measures included NRS, Oswestry Disability Index (ODI), Quebec Back Pain Disability Scale (QBPDS), and the FRP ratio via surface electromyography during trunk maximum flexion. We evaluated the participants at the baseline (T0), at the end of the 4-week treatment (T1), and at 4 weeks after the end of the treatment, at 8 weeks from the baseline (T2). Results: In this pilot RCT, 21 middle-aged adult women affected by CNLBP were randomly allocated with a ratio of 1:1 in the Pilates group, and in parallel in the control group. The experimental group showed a significant improvement in ODI and QBPDS scores compared to the control group, maintained at follow-up for ODI, along with an NRS reduction at T2. About FRP, Pilates has proven to be comparable to conventional treatment, showing no significant difference in FRR at T1 and T2. Only the experimental group exceeded the 9.5 cutoff at T2, as a protective predictive index for CNLBP. Conclusions: This pilot RCT provided preliminary evidence that Pilates might be an effective rehabilitation method, enhancing functioning and pain management in middle-aged adult women affected by CNLBP. The FRP study proves to be efficient in translating clinical assessments into rehabilitation assessment measures. Full article

Low back pain (LBP) is a highly prevalent musculoskeletal problem and a leading cause of disability worldwide. From a pathophysiological perspective, the contribution of inflammation to LBP is being increasingly recognized. In this literature review, we aim to provide an overview of the role of inflammation as a mediator of LBP while summarizing clinical studies investigating the potential role of anti-inflammatory treatments in the management of LBP. Although often controversial, the available evidence suggests an important role of inflammation in the pathogenesis of LBP, which can be further translated into novel therapeutic targets. Both anti-tumor necrosis factor (anti-TNF) and anti-nerve growth factor (anti-NGF) agents hold the potential of blocking inflammation and pain pathways in patients with chronic LBP. TNF inhibitors have been tested mostly in small trials with mixed results, and their long-term efficacy remains to be proven. Anti-NGF agents have demonstrated stronger and consistent efficacy in randomized controlled trials, but safety concerns compromise their widespread use. The potential role of other anti-inflammatory molecules is currently under investigation. Presently, the routine use of TNF or NGF inhibitors is not supported in radiculopathy or chronic LBP. However, novel anti-inflammatory therapies introduced in the rheumatology field appear to be promising for specific subsets of patients suffering from chronic, refractory LBP, with a complementary role as therapeutic tools, after the unsuccessful outcome of the conservative approach. Full article

Nanogenerators (NGs), especially triboelectric nanogenerators (TENGs), represent an emerging technology with great potential for self-powered lumbar motion monitoring. Conventional wearable systems for assessing spinal kinematics are often limited by their reliance on external power supplies, hindering long-term and real-time clinical applications. NGs can convert biomechanical energy from lumbar motion into electrical energy, providing both sensing and power-generation capabilities in a single platform. This review summarizes the fundamental working mechanisms, device architectures, and current progress of NG-based motion monitoring technologies, with a particular focus on their applications in lumbar spine research and clinical rehabilitation. By enabling high-sensitivity, continuous, and battery-free monitoring, NG-based systems may enhance the diagnosis and management of low back pain (LBP) and postoperative recovery assessment. Furthermore, the integration of NGs with wearable electronics, the Internet of Things (IoT), and artificial intelligence (AI) holds promise for developing intelligent, self-sustaining monitoring platforms that bridge biomedical engineering and spine medicine. Full article

Chronic low back pain (CLBP) is a significant global concern. Its prevalence continues to rise, and current management strategies demonstrate, at best, moderate effectiveness. The purpose of this study was to explore the concept of uncertainty tolerance and how it affects an individual’s ability to hope, as well as how both of these factors influence emotion regulation. These concepts are highly relevant for both patients and clinicians during CLBP consultations. A social constructivist meta-ethnographic study—a highly interpretative type of qualitative review—was conducted to generate new theory and provide valuable insights into this unique area of pain management. A framework was followed; its iterative analytical process involves multiple search strategies in accordance with PRISMA guidelines. The analysis explored relationships among studies, generated conceptual ideas, and ultimately developed a substantive theory. This review represents the first worked example of a theory generating review process. One model is created to illustrate how individuals with CLBP regulate their emotions; it also considers both the influencing factors and the resulting outcomes of this process. The model identifies pathways leading to either adaptive or maladaptive emotional regulation strategies. Tolerance of uncertainty and ability to hope are key concepts that influence emotion regulation and play a vital role in the physical and psychological well-being of people with CLBP. Further research is required to explore how the model can be operationalised in clinical practice. Full article

Background: Primary spinal gliomas are rare in the pediatric population. Separately, FGFR1 genomic aberrations are also uncommon in spinal cord tumors. We report a case of a previously well adolescent who presented with progressive symptoms secondary to an intramedullary tumor with unique radiological and molecular characteristics. Case Presentation: A previously well 17-year-old male presented with worsening mid-back pain associated with lower limb long-tract signs. Magnetic resonance imaging (MRI) of his neuro-axis reported a long-segment intramedullary lesion with enhancing foci and a multi-septate syrinx containing hemorrhagic components from C4 to T12. The largest enhancement focus was centered at T7. Additional MRI sequences observed no intracranial involvement or vascular anomaly. He underwent an emergent laminoplasty and excision of the thoracic lesion. Intraoperative findings demonstrated a soft, grayish intramedullary tumor associated with extensive hematomyelia that had multiple septations. Active fenestration of the latter revealed blood products in various stages of resolution. Postoperatively, the patient recovered well, with neurological improvement. Final histology reported a circumscribed low-grade glial neoplasm. Further molecular interrogation via next-generation sequencing panels showed FGFR1 p.K656E and V561M alterations. The unique features of this case are presented and discussed in corroboration with a focused literature review. Conclusions: We highlight an interesting case of an intramedullary tumor with unusual radiological and pathological findings. Emphasis is on the importance of tissue sampling in corroboration with genomic investigations to guide clinical management. Full article

Background: Degenerative lumbar spine disease is a prevalent cause of chronic low back pain that significantly impairs daily function and quality of life. While conservative management is the first line of treatment, many patients ultimately require instrumented lumbar spine surgery. However, postoperative outcomes vary considerably, with emerging evidence suggesting that preoperative psychological factors such as anxiety, depression, and pain catastrophizing may influence recovery. The SAP-LD (Scale for Anxiety and Pain in Lumbar Degeneration) study was designed to assess the prognostic role of these psychological and physical parameters in surgical outcomes. Methods: This prospective observational study enrolled 70 adult patients with degenerative lumbar spine pathology scheduled for instrumented surgical treatment at the University of Brescia and ASST Spedali Civili di Brescia between March and December 2024. Preoperative assessments included demographic, clinical, and radiologic data along with validated scales: the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS). Follow-up evaluations were performed at 45 days and at 6 months, and statistical analyses were conducted using correlation tests, ANOVA, and regression modeling. Results: The demographic analysis of the 70 enrolled patients shows a balanced gender distribution (38 females, 34 males) with a mean age of 61 years (range 23–81). The educational level distribution indicates that the majority of patients (44.29%) have a secondary education level, while 35.71% have a tertiary education level. Regarding employment status, 50% of the patients are retired or not working. Patients with clinically significant anxiety and/or depression showed higher levels of perceived pain, pain catastrophizing, and disability at baseline. These patients reported significantly worse scores on the Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS), and Oswestry Disability Index (ODI). The Oswestry Disability Index (ODI) demonstrates a clinically significant improvement (reduction) in disability between the preoperative period (t0) and the 45-day follow-up (t2), with the median decreasing from 39.00 to 13.00. However, there is a partial regression at the 6-month follow-up (t3), with the median increasing to 27.00. For the SF-36 Health Survey, the General Health subscale shows an improvement between t0 and t2 (median increasing from 55.00 to 60.00), followed by a slight decrease at t3 (median 55.00). Similar patterns are observed in most other subscales, with initial improvement followed by partial regression. The Pain Catastrophizing Scale (PCS) shows a substantial reduction in catastrophizing between t0 and t2 (median decreasing from 16.00 to 3.00), followed by an increase at t3 (median 11.00), though still below baseline levels. Pain intensity as measured by the Visual Analogue Scale (VAS) shows a significant reduction at t2 (median decreasing from 5.00 to 3.00), but increases again at t3 (median 6.00), even exceeding the preoperative level. For the Hospital Anxiety and Depression Scale (HADS), no significant differences were observed across time points, with values indicating mild symptoms throughout the study period. Correlation analyses confirmed that higher preoperative anxiety and depression scores were predictive of poorer postoperative outcomes. Specifically, higher HADS scores at baseline are associated with higher ODI scores (increased disability) at all time points (p = 0.002), higher VAS scores (increased pain) at all time points (p = 0.015), and lower scores on SF-36 subscales, particularly Emotional Well-being (p = 0.00023) and Social Functioning (p = 0.002). Higher PCS scores at baseline are associated with higher ODI scores at all time points (p = 0.001), higher VAS scores at all time points (p = 0.008), and lower scores on SF-36 subscales, particularly Pain (p = 0.00023) and Physical Functioning (p = 0.04254). The mixed linear models analysis confirms these findings, showing that the ODI score decreases significantly between t0 and t2 (p = 0.00023) and increases between t2 and t3, though this increase is not statistically significant (p = 0.079). For VAS scores, there is a significant decrease between t0 and t2 (p = 0.00023) and a significant increase between t2 and t3 (p = 0.04254). Patients with elevated preoperative HADS scores tended to have slower recovery trajectories and reported lower satisfaction levels. These findings reinforce the prognostic value of psychological assessments in spine surgery and suggest that targeted psychological interventions could improve patient outcomes. Conclusions: By identifying psychological predictors of postoperative recovery, this study underscores the importance of integrating preoperative psychological screening into routine clinical practice. The results suggest that a multidisciplinary approach, including both surgical and psychological care, could enhance long-term functional outcomes and quality of life for patients undergoing instrumented lumbar spine surgery. Full article