Prognostic factors in lumbar spinal stenosis surgery
Open Access
- 3 September 2012
- journal article
- Published by Medical Journals Sweden AB in Acta Orthopaedica
- Vol. 83 (5), 536-542
- https://doi.org/10.3109/17453674.2012.733915
Abstract
A considerable number of patients who undergo surgery for spinal stenosis have residual symptoms and inferior function and health-related quality of life after surgery. There have been few studies on factors that may predict outcome. We tried to find predictors of outcome in surgery for spinal stenosis using patient- and imaging-related factors. 109 patients in the Swedish Spine Register with central spinal stenosis that were operated on by decompression without fusion were prospectively followed up 1 year after surgery. Clinical outcome scores included the EQ-5D, the Oswestry disability index, self-estimated walking distance, and leg and back pain levels (VAS). Central dural sac area, number of levels with stenosis, and spondylolisthesis were included in the MRI analysis. Multivariable analyses were performed to search for correlation between patient-related and imaging factors and clinical outcome at 1-year follow-up. Several factors predicted outcome statistically significantly. Duration of leg pain exceeding 2 years predicted inferior outcome in terms of leg and back pain, function, and HRLQoL. Regular and intermittent preoperative users of analgesics had higher levels of back pain at follow-up than those not using analgesics. Low preoperative function predicted low function and dissatisfaction at follow-up. Low preoperative EQ-5D scores predicted a high degree of leg and back pain. Narrow dural sac area predicted more gains in terms of back pain at follow-up and lower absolute leg pain. Multiple factors predict outcome in spinal stenosis surgery, most importantly duration of symptoms and preoperative function. Some of these are modifiable and can be targeted. Our findings can be used in the preoperative patient information and aid the surgeon and the patient in a shared decision making process.Keywords
This publication has 33 references indexed in Scilit:
- Does the Duration of Symptoms in Patients With Spinal Stenosis and Degenerative Spondylolisthesis Affect Outcomes?Spine, 2011
- Correlation between disability and MRI findings in lumbar spinal stenosisActa Orthopaedica, 2011
- Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosisEuropean Spine Journal, 2010
- The Swedish Spine Register: development, design and utilityEuropean Spine Journal, 2009
- Gait analysis does not correlate with clinical and MR imaging parameters in patients with symptomatic lumbar spinal stenosisBMC Musculoskeletal Disorders, 2008
- Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR ImagingEuropean Spine Journal, 2008
- Surgical versus Nonsurgical Therapy for Lumbar Spinal StenosisNew England Journal of Medicine, 2008
- Electromyographic and Magnetic Resonance Imaging to Predict Lumbar Stenosis, Low-Back Pain, and No Back SymptomsThe Journal of Bone & Joint Surgery, 2007
- United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003Spine, 2006
- Does Additional Discectomy and the Degree of Dural Sac Compression Influence the Outcome of Decompressive Surgery for Lumbar Spinal Stenosis?Acta Neurochirurgica, 1999