Chronic Pain Despite Anatomical Success: A Prospective Cohort Study on One-Year Outcomes and Pain Predictors Following Spinopelvic Fixation for Trauma

Background While spinopelvic fixation effectively restores alignment in traumatic injuries, long-term patient-centered outcomes, particularly chronic pain, are poorly characterized. This study aimed to evaluate one-year multidimensional outcomes, with a focused analysis on the prevalence and predictors of chronic pain following this surgery. Methods A prospective cohort study was conducted at two trauma centers. Forty-five consecutive adult patients with traumatic spinopelvic instability undergoing fixation were enrolled. Outcomes included the Majeed Pelvic Score (MPS), pain (VAS), function (SF-36 PF, Barthel Index), and radiographic alignment. Chronic pain (VAS > 4 for ≥ 2 months beyond 3 months post-op) was a primary focus. Regression analysis was performed to identify predictors of chronic pain. Assessments occurred preoperatively and at 2 weeks, 1, 3, 6, and 12 months. Results The cohort (mean age 41.9 ± 13.5; 73.3% male) showed significant improvement in MPS (from 35.0 ± 8.2 to 84.0 ± 7.1 at one year, p < 0.001) and radiographic parameters (p < 0.001). Despite an overall reduction in mean VAS, chronic pain was prevalent in 77.8% (n = 35). In multivariate logistic regression, independent predictors of chronic pain at one year included higher preoperative VAS (OR = 1.8, 95%CI 1.2–2.7, p = 0.004), the presence of neurological injury at presentation (OR = 4.3, 95%CI 1.1–16.9, p = 0.037), and less optimal postoperative radiographic reduction (vertical displacement > 5mm) (OR = 3.5, 95%CI 1.2–10.1, p = 0.021). The complication rate was 20%. Conclusion Spinopelvic fixation leads to excellent functional and radiographic outcomes. However, chronic pain remains a highly prevalent and distinct challenge. We identified preoperative pain intensity, neurological injury, and suboptimal reduction as key predictors. These findings argue for a stratified postoperative approach, integrating advanced pain management and neurological rehabilitation from the outset for high-risk patients, beyond achieving anatomical success alone. Level of Evidence: III ( prognostic study).