Comparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational study

IntroductionLumbar spinal stenosis is a common cause of low back and leg pain in the elderly and affects both physical activity and quality of life. First-line treatments are non-surgical options but if unsuccessful, surgery is advocated. The literature is not clear as to the outcome of surgery compared with non-surgical treatment, and the optimal time for surgery is not explicit. This observational study is designed to investigate the course of treatment, compare effectiveness of surgical and non-surgical management in patients with lumbar spinal stenosis and identify prognostic factors for outcome in the context of current clinical practice.Materials and analysisProspectively registered data on treatment, outcome and patient characteristics are collected from nationwide registers on health and social issues, a clinical registry of people with chronic back pain and hospital medical records. Primary outcome is change in physical function measured by the Zurich Claudication Questionnaire. Secondary outcomes are changes in symptom severity, pain-related function, health-related quality of life and general self-efficacy. Outcomes are assessed at baseline and 6 and 12 months. Outcomes at 12 months will be compared for patients who undergo surgery for lumbar spinal stenosis and patients managed non-surgically, using different analytical approaches. Prespecified prognostic factors of interest at baseline include treatment allocation, back and leg pain intensity, comorbidity, duration of symptoms, pretreatment function, self-rated health, income, general self-efficacy and MRI-graded severity of central stenosis.Ethics and disseminationThe study has been evaluated by the Regional Committees on Health Research for Southern Denmark (S-20172000–200) and notified to the Danish Data Protection Agency (18/22336). All participants provide consent. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences according to the Strengthening the Reporting of Observational Studies in Epidemiology and Prognosis Research Strategy statements. Potential sources of bias will be addressed using Risk of Bias in Non-randomised Studies of Interventions.Trial registration numberNCT03548441; Pre-results.

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Association between payer status and patient-reported outcomes in adult patients with lumbar spinal stenosis treated with decompression surgery

Journal of Neurosurgery Spine ◽

10.3171/2018.7.spine18294 ◽

2019 ◽

Vol 30 (2) ◽

pp. 198-210 ◽

Cited By ~ 1

Author(s):

Galal Elsayed ◽

Samuel G. McClugage ◽

Matthew S. Erwood ◽

Matthew C. Davis ◽

Esther B. Dupépé ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Private Insurance ◽

Mean Difference ◽

Leg Pain ◽

Decompression Surgery ◽

Patient Reported ◽

Lumbar Spinal

OBJECTIVEInsurance disparities can have relevant effects on outcomes after elective lumbar spinal surgery. The aim of this study was to evaluate the association between private/public payer status and patient-reported outcomes in adult patients who underwent decompression surgery for lumbar spinal stenosis.METHODSA sample of 100 patients who underwent surgery for lumbar spinal stenosis from 2012 to 2014 was evaluated as part of the prospectively collected Quality Outcomes Database at a single institution. Outcome measures were evaluated at 3 months and 12 months, analyzed in regard to payer status (private insurance vs Medicare/Veterans Affairs insurance), and adjusted for potential confounders.RESULTSAt baseline, patients had similar visual analog scale back and leg pain, Oswestry Disability Index, and EQ-5D scores. At 3 months postintervention, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.11, p < 0.001) and more leg pain (mean difference 1.26, p = 0.05). At 12 months, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.14, p < 0.001). There were no significant differences at 3 months or 12 months between groups for back pain (p = 0.14 and 0.43) or disability (p = 0.19 and 0.15). Across time points, patients in both groups showed improvement at 3 months and 12 months in all 4 functional outcomes compared with baseline (p < 0.001).CONCLUSIONSBoth private and public insurance patients had significant improvement after elective lumbar spinal surgery. Patients with public insurance had slightly less improvement in quality of life after surgery than those with private insurance but still benefited greatly from surgical intervention, particularly with respect to functional status.

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Prediction of walking ability following posterior decompression for lumbar spinal stenosis

European Spine Journal ◽

10.1007/s00586-021-06938-6 ◽

2021 ◽

Author(s):

Suzanne McIlroy ◽

Feroz Jadhakhan ◽

David Bell ◽

Alison Rushton

Keyword(s):

Quality Of Life ◽

Higher Education ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Walking Distance ◽

Walking Ability ◽

Poor Outcome ◽

Lumbar Spinal ◽

Reduced Risk

Abstract Purpose Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. Methods An observational cohort study was conducted using data from the British Spine Registry (2017–2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed. Results 14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome. Conclusion Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.

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Health-related quality of life and comorbidities associated with lumbar spinal stenosis

The Spine Journal ◽

10.1016/j.spinee.2011.11.009 ◽

2012 ◽

Vol 12 (3) ◽

pp. 189-195 ◽

Cited By ~ 33

Author(s):

Michele C. Battié ◽

C. Allyson Jones ◽

Donald P. Schopflocher ◽

Richard W. Hu

Keyword(s):

Quality Of Life ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Lumbar Spinal

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The effectiveness of vitamin D supplementation in functional outcome and quality of life (QoL) of lumbar spinal stenosis (LSS) requiring surgery

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01629-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Sangbong Ko ◽

Seungbum Chae ◽

Wonkee Choi ◽

Jaibum Kwon ◽

Je-Yong Choi

Keyword(s):

Quality Of Life ◽

Vitamin D ◽

Functional Outcome ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Vitamin D Supplementation ◽

Lumbar Spinal

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Long-term Clinical Outcomes and Quality of Life in Elderly Patients Treated with Interspinous Devices for Lumbar Spinal Stenosis

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1604280 ◽

2017 ◽

Vol 79 (02) ◽

pp. 139-144 ◽

Cited By ~ 4

Author(s):

Massimo Miscusi ◽

Stefano Forcato ◽

Alessandro Ramieri ◽

Filippo Polli ◽

Antonino Raco ◽

...

Keyword(s):

Quality Of Life ◽

Elderly Patients ◽

Spinal Stenosis ◽

Local Anesthesia ◽

Lumbar Spinal Stenosis ◽

Short Form ◽

Meaningful Improvement ◽

Lumbar Spinal

Background and Objective Lumbar spinal stenosis (LSS) is a common degenerative condition that occurs in the spine with increasing age. Clinically, LSS causes a progressive reduction in walking autonomy, resulting in a poor quality of life and impaired functional capacity. The aim of this study was to evaluate the clinical outcome and quality of life of elderly patients presenting with LSS and associated comorbidities after a 5-year follow-up who were treated with an interspinous process device (IPD). Material and Methods Sixty patients > 75 years of age presenting with symptomatic degenerative LSS were included. All were treated with an IPD under local anesthesia. American Society of Anesthesiology score, Zurich Claudication Questionnaire, and Short Form 36 were evaluated pre- and postoperatively and at the follow-up visit each year for 5 years. Results The mean surgery time while under local anesthesia was 20 minutes. Forty-eight patients were followed for 5 years. Significant clinical improvements in all outcome scores (p < 0.05) both postoperatively or at follow-up were found. Conclusions IPD seems to be an effective and safe treatment for LSS in elderly patients with general comorbidities. In our study, all followed up patients had a meaningful improvement of their quality of life even at 5 years after surgery.

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