Factors Influencing Patient Satisfaction After Decompression Surgery Without Fusion for Lumbar Spinal Stenosis

Study Design: Retrospective cohort study. Objectives: Decompression without fusion is a standard surgical treatment for lumbar spinal stenosis (LSS) with reasonable surgical outcomes. Nevertheless, some studies have reported low patient satisfaction (PS) following decompression surgery. The cause of the discrepancy between reasonable clinical outcomes and PS is unknown; moreover, the factors associated with PS are expected to be complex, and little is known about them. This study aimed to identify satisfaction rate and to clarify the factors related to PS following decompression surgery in LSS patients. Methods: We retrospectively reviewed 126 patients who underwent lumbar decompression with a minimum follow-up of 1 year. Patients were divided into 2 groups based on the PS question. The Japanese Orthopaedic Association (JOA) scores, and the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness were compared between the 2 groups preoperatively and at the latest visit. To identify the prognostic factors for dissatisfaction, multiple logistic regression analysis was performed. Results: Overall satisfaction rate was 75%. The JOA recovery rate, NRS improvement, and Short Form–8 (SF-8) were significantly higher in the satisfied group. Postoperative NRS scores of LBP, leg pain, and leg numbness were significantly lower in the satisfied group. Multivariate logistic regression analysis showed that smoking and scoliosis were significant risk factors for dissatisfaction. Conclusions: Overall satisfaction rate was 75% in patients with LSS undergoing decompression surgery. This study found that smoking status and scoliosis were associated with patient dissatisfaction following decompression in LSS patients.

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Prognostic Factors for Satisfaction After Decompression Surgery for Lumbar Spinal Stenosis

Neurosurgery ◽

10.1093/neuros/nyx298 ◽

2017 ◽

Vol 82 (5) ◽

pp. 645-651 ◽

Cited By ~ 12

Author(s):

Rune Tendal Paulsen ◽

Jamal Bech Bouknaitir ◽

Søren Fruensgaard ◽

Leah Carreon ◽

Mikkel Andersen

Keyword(s):

Patient Satisfaction ◽

Prognostic Factors ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Smoking Status ◽

Leg Pain ◽

Decompression Surgery ◽

Posterior Decompression ◽

Walking Capacity ◽

Lumbar Spinal

Abstract BACKGROUND Surgical treatment for lumbar spinal stenosis is associated with both short- and long-term benefits with improvements in patient function and pain. Even though most patients are satisfied postoperatively, some studies report that up to one-third of patients are dissatisfied. OBJECTIVE To present clinical outcome data and identify prognostic factors related to patient satisfaction 1 yr after posterior decompression surgery for lumbar spinal stenosis. METHODS This multicenter register study included 2562 patients. Patients were treated with various types of posterior decompression. Patients with previous spine surgery or concomitant fusion were excluded. Patient satisfaction was analyzed for associations with age, sex, body mass index, smoking status, duration of pain, number of decompressed vertebral levels, comorbidities, and patient-reported outcome measures, which were used to quantify the effect of the surgical intervention. RESULTS At 1-yr follow-up, 62.4% of patients were satisfied but 15.1% reported dissatisfaction. The satisfied patients showed significantly greater improvement in all outcome measures compared to the dissatisfied patients. The outcome scores for the dissatisfied patients were relatively unchanged or worse compared to baseline. Association was seen between dissatisfaction, duration of leg pain, smoking status, and patient comorbidities. Patients with good walking capacity at baseline were less prone to be dissatisfied compared to patients with poor walking capacity. CONCLUSION This study found smoking, long duration of leg pain, and cancerous and neurological disease to be associated with patient dissatisfaction, whereas good walking capacity at baseline was positively associated with satisfaction after 1 yr.

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Impact of leg numbness on patient satisfaction following decompression surgery for lumbar spinal stenosis

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.09.018 ◽

2021 ◽

Vol 93 ◽

pp. 112-115

Author(s):

Yoji Ogura ◽

Yoshiyuki Takahashi ◽

Takahiro Kitagawa ◽

Yoshiro Yonezawa ◽

Kodai Yoshida ◽

...

Keyword(s):

Patient Satisfaction ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Decompression Surgery ◽

Lumbar Spinal

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Outcome measures reflecting patient satisfaction following decompression surgery for lumbar spinal stenosis: Comparison of major outcome measures

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.105710 ◽

2020 ◽

Vol 191 ◽

pp. 105710

Author(s):

Yoji Ogura ◽

Yoshiomi Kobayashi ◽

Takahiro Kitagawa ◽

Yoshiro Yonezawa ◽

Yoshiyuki Takahashi ◽

...

Keyword(s):

Patient Satisfaction ◽

Spinal Stenosis ◽

Outcome Measures ◽

Lumbar Spinal Stenosis ◽

Decompression Surgery ◽

Lumbar Spinal

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The Change of Lumbar Spinal Stenosis Symptoms over a Six-Year Period in Community-Dwelling People

Medicina ◽

10.3390/medicina57101116 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1116

Author(s):

Koji Otani ◽

Shin-ichi Kikuchi ◽

Shoji Yabuki ◽

Takuya Nikaido ◽

Kazuyuki Watanabe ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Predictive Factors ◽

Time Course ◽

Multiple Logistic Regression Analysis ◽

Multiple Logistic Regression ◽

Lumbar Spinal

Background and Objectives: The high prevalence of lumbar spinal stenosis (LSS) and its negative impact on quality of life in the elderly is well known. However, the longitudinal time course of LSS symptoms remains unclear. The purpose of this study was to clarify the longitudinal time course and associated factors of LSS symptoms over a period of six years in a community. Materials and Methods: This study was conducted with data prospectively collected in 2004 and 2010 under a retrospective design. In 2004, 1578 subjects (age range: 40 to 79 years) were interviewed on LSS symptoms using a specially designed and validated questionnaire. In 2010, a follow-up study was performed by mail, to which 789 subjects of the 2004 study population responded. Considering that the presence of osteoarthritis (OA) of the knee or hip may influence the participants’ answers in the questionnaire, analysis was performed in all 789 subjects with and 513 subjects without either knee or hip OA. Changes in LSS symptoms between the initial and the 6-year survey were investigated. Multiple logistic regression analysis was used for detecting the risk factors for LSS symptom presence at the six-year follow-up. Results: 1. At the six-year follow-up, more than half of the subjects who showed LSS symptoms at the initial analysis became LSS-negative, and 12–15% of those who were LSS-negative became LSS-positive. 2. From the multiple logistic regression analysis, a lower Roland-Morris Disability Questionnaire (RDQ) score and a positive LSS symptom at the initial analysis were detected as predictive factors of the presence of LSS symptoms at the six-year follow-up in the total number of subjects, as well as just in those who did not have either knee or hip OA. Conclusions: More than half of the subjects who were LSS-positive at their initial assessment still experienced improvement in their symptoms even after 6 years. This means that both LSS symptoms and their time course vary from person to person. Predictive factors for the presence of LSS symptoms during the six-year follow-up period were RDQ score and positive LSS symptoms.

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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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Lumbar Spinal Stenosis Associated With Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-analysis of Secondary Fusion Rates Following Open vs Minimally Invasive Decompression

Neurosurgery ◽

10.1093/neuros/nyw091 ◽

2017 ◽

Vol 80 (3) ◽

pp. 355-367 ◽

Cited By ~ 37

Author(s):

Karsten Schöller ◽

Marjan Alimi ◽

Guang-Ting Cong ◽

Paul Christos ◽

Roger Härtl

Keyword(s):

Systematic Review ◽

Patient Satisfaction ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Meta Analysis ◽

Decompression Surgery ◽

Lumbar Spinal ◽

Lumbar Spondylolisthesis ◽

Minimally Invasive Decompression

Abstract BACKGROUND: Decompression without fusion is a treatment option in patients with lumbar spinal stenosis (LSS) associated with stable low-grade degenerative spondylolisthesis (DS). A minimally invasive unilateral laminotomy (MIL) for “over the top” decompression might be a less destabilizing alternative to traditional open laminectomy (OL). OBJECTIVE: To review secondary fusion rates after open vs minimally invasive decompression surgery. METHODS: We performed a literature search in Pubmed/MEDLINE using the keywords “lumbar spondylolisthesis” and “decompression surgery.” All studies that separately reported the outcome of patients with LSS+DS that were treated by OL or MIL (transmuscular or subperiosteal route) were included in our systematic review and meta-analysis. The primary end point was secondary fusion rate. Secondary end points were total reoperation rate, postoperative progression of listhetic slip, and patient satisfaction. RESULTS: We identified 37 studies (19 with OL, 18 with MIL), with a total of 1156 patients, that were published between 1983 and 2015. The studies’ evidence was mostly level 3 or 4. Secondary fusion rates were 12.8% after OL and 3.3% after MIL; the total reoperation rates were 16.3% after OL and 5.8% after MIL. In the OL cohort, 72% of the studies reported a slip progression compared to 0% in the MIL cohort, respectively. After OL, satisfactory outcome was 62.7% compared to 76% after MIL. CONCLUSION: In patients with LSS and DS, minimally invasive decompression is associated with lower reoperation and fusion rates, less slip progression, and greater patient satisfaction than open surgery.

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Education level as a prognostic indicator at 12 months following decompression surgery for symptomatic lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2018.6.spine18226 ◽

2019 ◽

Vol 30 (1) ◽

pp. 60-68

Author(s):

Galal A. Elsayed ◽

Esther B. Dupépé ◽

Matthew S. Erwood ◽

Matthew C. Davis ◽

Samuel G. McClugage ◽

...

Keyword(s):

Patient Education ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Functional Outcomes ◽

College Education ◽

Education Level ◽

Leg Pain ◽

Decompression Surgery ◽

Significant Difference ◽

Lumbar Spinal

OBJECTIVEThe goal of this study was to analyze the effect of patient education level on functional outcomes following decompression surgery for symptomatic lumbar spinal stenosis.METHODSPatients with surgically decompressed symptomatic lumbar stenosis were collected in a prospective observational registry at a single institution between 2012 and 2014. Patient education level was compared to surgical outcomes to elucidate any relationships. Outcomes were defined using the Oswestry Disability Index score, back and leg pain visual analog scale (VAS) score, and the EuroQol–5 Dimensions questionnaire score.RESULTSOf 101 patients with symptomatic lumbar spinal stenosis, 27 had no college education and 74 had a college education (i.e., 2-year, 4-year, or postgraduate degree). Preoperatively, patients with no college education had statistically significantly greater back and leg pain VAS scores when compared to patients with a college education. However, there was no statistically significant difference in quality of life or disability between those with no college education and those with a college education. Postoperatively, patients in both cohorts improved in all 4 patient-reported outcomes at 3 and 12 months after treatment for symptomatic lumbar spinal stenosis.CONCLUSIONSDespite their education level, both cohorts showed improvement in their functional outcomes at 3 and 12 months after decompression surgery for symptomatic lumbar spinal stenosis.

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Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01968-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hua Li ◽

Yufu Ou ◽

Furong Xie ◽

Weiguo Liang ◽

Gang Tian ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Discectomy ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Pain Scores ◽

Endoscopic Lumbar Discectomy ◽

Lumbar Spinal

Abstract Background Although percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (ages 65–74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P < 0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P > 0.05). Conclusion PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

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