Dietary inadequacies and their association with pain severity and disc degeneration in patients surgically treated for degenerative lumbosacral spine disorders

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Background: Intervertebral disc degeneration (IVDD) and lumbar spinal stenosis (LSS) are leading causes of musculoskeletal disability, and dietary factors are increasingly implicated in their progression, yet nutritional profiling in surgically treated patients remains scarce. Objective: To evaluate dietary intake and nutrient inadequacies in surgical spine patients and their associations with clinical outcomes. Design: Cross-sectional study of 200 IVDD (microdiscectomy) and 180 LSS (hemilaminectomy) patients. Dietary intake was assessed using repeated 24-h recalls and compared with Estimated Energy Requirement (EER), Estimated Average Requirement (EAR), and Adequate Intake (AI) reference values. Associations between nutrient intake and pain severity, measured with the Visual Analog Scale (VAS), disc degeneration (Pfirrmann grade), and, in the LSS cohort, radiological stenosis severity were examined using multivariable regression models in which all candidate nutrients were entered simultaneously with demographic, anthropometric, and lifestyle covariates (age, sex, body mass index (BMI), energy intake, smoking, diabetes, alcohol use, occupation, education), with false discovery rate (FDR) correction for multiple comparisons. Results: Both cohorts showed consistent, pronounced dietary inadequacies. Over 80% of participants had insufficient eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake, up to 95% of men had inadequate fiber intake, and over 90% did not meet recommended vitamin D intake. Approximately 70% had inadequate folate intake, and calcium intake was below recommended levels in most patients across subgroups. In simultaneous multivariable models adjusted for the full covariate panel, no nutrient retained a significant independent association with VAS, Pfirrmann grade, or radiological stenosis severity after FDR correction; nominal, uncorrected associations were observed for magnesium and zinc with pain severity in the LSS cohort only. Conclusion: Surgically treated spine patients show widespread inadequate intake of several nutrients relevant to musculoskeletal and connective tissue health, most notably vitamin D, calcium, fiber, and omega-3 fatty acids. Although independent associations with pain and radiological severity were not confirmed after adjustment, the high prevalence of dietary inadequacy supports consideration of routine nutritional screening, and prospective studies incorporating serum biomarkers are warranted to clarify whether a causal relationship exists.

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