Developing an Instrument for Measuring Walking Ability in Patients With Spinal Stenosis

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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Quantification of walking ability in subjects with neurogenic claudication from lumbar spinal stenosis—a comparative study

The Spine Journal ◽

10.1016/j.spinee.2011.12.006 ◽

2012 ◽

Vol 12 (2) ◽

pp. 101-109 ◽

Cited By ~ 40

Author(s):

James Rainville ◽

Lisa A. Childs ◽

Enrique B. Peña ◽

Pradeep Suri ◽

Janet C. Limke ◽

...

Keyword(s):

Comparative Study ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Neurogenic Claudication ◽

Walking Ability ◽

Lumbar Spinal

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Effective of Fusion in the Treatment of Lumbar Spinal Stenosis：A Systematic Review Andmeta-Analysis

10.21203/rs.3.rs-868342/v1 ◽

2021 ◽

Author(s):

Yang Yang ◽

Shi-tian Tang ◽

Qian Chen ◽

fang chen

Keyword(s):

Systematic Review ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Major Complication ◽

Primary Objective ◽

Leg Pain ◽

Walking Ability ◽

Degenerative Lumbar Spinal Stenosis ◽

Pain Scores ◽

Lumbar Spinal

Abstract Objective: The debate on efficacy of fusion added to decompression for lumbar spinal stenosis (LSS) is ongoing. The primary objective of this systematic review is to compare the outcome after decompression with and without fusion in patients with lumbar spinal stenosis .Methods: A literature search was performed in the Web of Science, EMBASE, Pubmed,and Cochrane Libraryfrom January 1990 to May 2021.The information of screened studies included clinical outcomes, and secondary measures, then data synthesis and meta-analysis were progressed.Data analysis was conducted using the Review Manager 5.0 software.Results: 17 studies were included in the analysis involving 2947 patients in total. In the majority of studies, including seven RCTs and ten observational studies. The pooled data revealed that fusion was associated with signifificantly higher rates of back pain scores when compared with decompression alone in RCT subgroup(SMD=-0.42, 95% CI (–0.60, -0.23), Z=4.31 P<0.0001).However, fusion signifificantly increased the intraoperative blood loss, operative time and hospital stay. Both techniques had similar leg Pain scores , EQ-5D, walking ability，ODI，major complication,clinical satisfactions and reoperation rate.Conclusions: Our studies showed that the additional fusion in the management of LSS yielded no clinical improvements over decompression alone within a 1-year follow-up period. We suggested that the least invasive and least costly procedure, being decompression alone, is preferred in patients with degenerative lumbar spinal stenosis. The appropriate surgical protocol for LSS should be discussed further.

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Critically appraised paper: Comprehensive non-surgical treatment leads to improved walking ability in people with lumbar spinal stenosis [commentary]

Journal of Physiotherapy ◽

10.1016/j.jphys.2019.04.006 ◽

2019 ◽

Vol 65 (3) ◽

pp. 174

Author(s):

Kjersti Storheim

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Walking Ability ◽

Lumbar Spinal ◽

Non Surgical Treatment

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Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2018.05.014 ◽

2018 ◽

Vol 99 (12) ◽

pp. 2408-2419.e2 ◽

Cited By ~ 6

Author(s):

Carlo Ammendolia ◽

Pierre Côté ◽

Danielle Southerst ◽

Michael Schneider ◽

Brian Budgell ◽

...

Keyword(s):

Randomized Trial ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Nonsurgical Treatment ◽

Walking Ability ◽

Lumbar Spinal

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Unfolding the outcomes of surgical treatment of lumbar spinal stenosis—a prospective 5- and 10-year follow-up study

European Spine Journal ◽

10.1007/s00586-020-06424-5 ◽

2020 ◽

Vol 29 (9) ◽

pp. 2231-2242

Author(s):

I. Tuomainen ◽

T Aalto ◽

J. Pesonen ◽

M. Rade ◽

M. Pakarinen ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Surgical Outcomes ◽

Walking Distance ◽

Walking Ability ◽

Pain Disability ◽

Study Results ◽

The Mean ◽

Lumbar Spinal

Abstract Purpose In this prospective study, we aim to determine surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery. Methods The study population consisted of 96 LSS patients who underwent decompressive surgery, 72 of whom participated in the 10-year follow-up. The patients completed a questionnaire preoperatively and 3 months, 5 years, and 10 years postoperatively. Outcome measures were satisfaction with the surgical outcomes, the Oswestry Disability Index (ODI), the visual analog scale (VAS), the numeric rating scale (NRS-11), and walking ability quantified in meters. Postoperative improvements at 5 and 10 years were analyzed using linear mixed models. Furthermore, comparisons between postoperative time points were made for clinical courses of pain, disability, and walking ability. Results At the 10-year follow-up, 68% of the patients were satisfied with the surgical outcomes. All the measured outcomes showed statistically significant improvement from baseline to the 5- and 10-year follow-up. The mean VAS score was 9.8 mm higher at the 5-year follow-up and 7.8 mm at the 10-year follow-up compared to the 3-month follow-up point. Similarly, the mean ODI was 4.8% higher at the 10-year follow-up compared to the 3-month follow-up point. Conclusion This study reports the clinical course of pain, disability, and walking distance after LSS surgery with the 10-year follow-up. Based on our study results, patients with LSS could expect to have positive effects of their back surgery up to 10 years. However, minor worsening in pain and disability may occur and one-fourth of the patients may need a reoperation during the 10-year follow-up period.

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