Association of postlaminectomy syndrome with cardiovascular events in patients undergoing posterior lumbar fusion

Postlaminectomy syndrome (PLS) is a chronic pain condition characterized by persistent or recurrent symptoms after lumbar spine surgery. Although chronic pain states have been linked to autonomic dysregulation, inflammation, and increased cardiometabolic burden, the long-term cardiovascular implications of PLS remain unclear. Posterior lumbar fusion (PLF) is one of the most common lumbar procedures, providing a clinically relevant population in which to evaluate whether PLS signals broader cardiovascular vulnerability.

We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults aged ≥18 years who underwent PLF between 2015 and 2020 were identified by CPT codes. The exposed cohort included individuals with a new diagnosis of PLS (ICD-10 M96.1) occurring ≥6 months after fusion; matched controls were assigned an index encounter at the corresponding postoperative interval. Outcomes included major cardiac events (MCE), stroke, and MACE (MCE + stroke) within 5 years. Propensity score matching was performed based on demographics, comorbidities, and medication use. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

After matching, 6384 patients were included in each cohort. PLS was associated with increased 5-year risk of MACE (12.3% vs 10.8%; OR 1.16, 95% CI 1.04-1.29) and MCE (9.9% vs 8.1%; OR 1.26, 95% CI 1.11-1.42). Stroke risk was not significantly different (OR 1.11, 95% CI 0.92-1.34).

PLS after PLF is associated with elevated long-term cardiac risk. These findings suggest PLS may represent a marker of broader systemic vulnerability, warranting enhanced cardiovascular surveillance and multidisciplinary postoperative management.