Association between preoperative activity level and functional outcome at 12 months following surgical decompression for lumbar spinal stenosis

OBJECTIVEThis study defines the association of preoperative physical activity level with functional outcomes at 3 and 12 months following surgical decompression for lumbar spinal stenosis.METHODSData were collected as a prospective observational registry at a single institution from 2012 through 2015, and then analyzed with a retrospective cohort design. Patients who were able to participate in activities outside the home preoperatively were compared to patients who did not participate in such activities, with respect to 3-month and 12-month functional outcomes postintervention, adjusted for relevant confounders.RESULTSNinety-nine patients were included. At baseline, sedentary/inactive patients (n = 55) reported greater back pain, lower quality of life, and higher disability than similarly treated patients who were active preoperatively. Both cohorts experienced significant improvement from baseline in back pain, leg pain, disability, and quality of life at both 3 and 12 months after lumbar decompression surgery. At 3 months postintervention, sedentary/inactive patients reported more leg pain and worse disability than patients who performed activities outside the home preoperatively. However, at 12 months postintervention, there were no statistically significant differences between the two cohorts in back pain, leg pain, quality of life, or disability. Multivariate analysis revealed that sedentary/inactive patients had improved disability and higher quality of life after surgery compared to baseline. Active patients experienced greater overall improvement in disability compared to inactive patients.CONCLUSIONSSedentary/inactive patients have a more protracted recovery after lumbar decompression surgery for spinal stenosis, but at 12 months postintervention can expect to reach similar long-term outcomes as patients who are active/perform activities outside the home preoperatively.

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Clinical implications of lumbar developmental spinal stenosis on back pain, radicular leg pain, and disability

The Bone & Joint Journal ◽

10.1302/0301-620x.103b1.bjj-2020-1186.r2 ◽

2021 ◽

Vol 103-B (1) ◽

pp. 131-140

Author(s):

Marcus Kin Long Lai ◽

Prudence Wing Hang Cheung ◽

Dino Samartzis ◽

Jaro Karppinen ◽

Kenneth Man Chee Cheung ◽

...

Keyword(s):

Quality Of Life ◽

Back Pain ◽

Spinal Stenosis ◽

Large Scale ◽

Leg Pain ◽

Decompression Surgery ◽

Study Cohort ◽

The Past ◽

Canal Diameter

Aims To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability. Methods This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions. Results Subjects with DSS had higher prevalence of radicular leg pain, more pain-related disability, and lower quality of life (all p < 0.05). Subjects with DSS had 1.5 (95% confidence interval (CI) 1.0 to 2.1; p = 0.027) and 1.8 (95% CI 1.3 to 2.6; p = 0.001) times higher odds of having radicular leg pain in the past month and the past year, respectively. However, DSS was not associated with LBP. Although, subjects with a spondylolisthesis had 1.7 (95% CI 1.1 to 2.5; p = 0.011) and 2.0 (95% CI 1.2 to 3.2; p = 0.008) times greater odds to experience LBP in the past month and the past year, respectively. Conclusion This large-scale study identified DSS as a risk factor of acute and chronic radicular leg pain. DSS was seen in 6.9% of the study cohort and these patients had narrower spinal canals. Subjects with DSS had earlier onset of symptoms, more severe radicular leg pain, which lasted for longer and were more likely to have worse disability and poorer quality of life. In these patients there is an increased likelihood of nerve root compression due to a pre-existing narrowed canal, which is important when planning surgery as patients are likely to require multi-level decompression surgery. Cite this article: Bone Joint J 2021;103-B(1):131–140.

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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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Gender Differences in Pre- and Postoperative Health-Related Quality of Life Measures in Patients Who Have Had Decompression Surgery for Lumbar Spinal Stenosis

Asian Spine Journal ◽

10.31616/asj.2019.0067 ◽

2020 ◽

Vol 14 (2) ◽

pp. 238-244 ◽

Cited By ~ 1

Author(s):

Yoshiomi Kobayashi ◽

Yoji Ogura ◽

Takahiro Kitagawa ◽

Yoshiro Yonezawa ◽

Yohei Takahashi ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Leg Pain ◽

Decompression Surgery ◽

Health Related Quality ◽

Men And Women ◽

Related Quality ◽

Health Related ◽

Lumbar Spinal

Study Design: Retrospective chart audit.Purpose: This study aimed to investigate the gender difference in pre- and postoperative health-related quality of life (HRQOL) in patients who have had decompression surgery for lumbar spinal stenosis (LSS).Overview of Literature: Gender differences may contribute to variations in disease presentations and health outcomes. The influence of gender on pre- and postoperative HRQOL in spinal disorders remains unclear.Methods: We reviewed 125 patients (79 men and 46 women) who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed the following clinical information: Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain (LBP), leg pain, and leg numbness; Zurich Claudication Questionnaire; JOA Back Pain Evaluation Questionnaire; Roland- Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as HRQOL. We compared the HRQOLs of men and women pre- and postoperatively.Results: Although the preoperative NRS results for LBP were significantly higher in women (p <0.05), there were no significant differences in clinical outcomes between men and women postoperatively. For HRQOL, the RMDQ scores were significantly worse in women preoperatively (p <0.05), but no significant differences were found postoperatively between men and women. Similarly, the SF-8 mental health score was also significantly lower in women preoperatively (p <0.05), but no significant differences were noted between the two groups postoperatively.Conclusions: LSPSL greatly reduced LBP, leg pain, and leg numbness in both genders. There were limited differences in pain and several HRQOL questionnaire responses between men and women after surgery. We found that women had greater sensitivity to and/or lower tolerance for pain than men, which led to lower HRQOL mental health scores preoperatively.

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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

BMJ Open ◽

10.1136/bmjopen-2018-024949 ◽

2018 ◽

Vol 8 (12) ◽

pp. e024949 ◽

Cited By ~ 2

Author(s):

Helle Algren Brøgger ◽

Thomas Maribo ◽

Robin Christensen ◽

Berit Schiøttz-Christensen

Keyword(s):

Quality Of Life ◽

Prognostic Factors ◽

Observational Study ◽

Spinal Stenosis ◽

Surgical Management ◽

Lumbar Spinal Stenosis ◽

Leg Pain ◽

Lumbar Spinal ◽

General Self Efficacy

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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Pregabalin for Refractory Radicular Leg Pain due to Lumbar Spinal Stenosis: A Preliminary Prospective Study

Pain Research and Management ◽

10.1155/2016/5079675 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 10

Author(s):

Sumihisa Orita ◽

Masaomi Yamashita ◽

Yawara Eguchi ◽

Miyako Suzuki ◽

Gen Inoue ◽

...

Keyword(s):

Back Pain ◽

Adverse Events ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Japanese Orthopaedic Association ◽

Leg Pain ◽

Vas Scores ◽

Inflammatory Drugs ◽

Lumbar Spinal

We investigated the efficacy of pregabalin (PGB) for neuropathic leg pain in lumbar spinal stenosis (LSS) patients with disturbed activities of daily living (ADL)/quality of life (QOL) in a prospective observational study. Subjects were a total of 104 LSS patients with neuropathic pain (NeP) in leg and neurological intermittent claudication (IMC) refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) for at least a month. NeP was identified using screening tool, Pain DETECT questionnaire. Visual analog scale (VAS) scores and responses to the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and 6 weeks after PGB treatment initiation. Changes in IMC distance and adverse events were also recorded. PGB significantly improved their VAS scores for pain and sleep quality (P<0.001). With respect to JOABPEQ, significant improvements were observed with regard to the following dimensions: pain-related disorders (P<0.01), lumbar spine dysfunction (P=0.031), gait disturbance (P=0.028), and psychological disorders (P=0.014). The IMC distance showed an improvement tendency after PGB treatment, albeit with no significance (P=0.063). Minor adverse events such as dizziness were observed. PGB can be effective for neuropathic leg pain refractory to NSAIDs in LSS patients, resulting in not only pain control but also improving lower back pain-related ADL/QOL scores.

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IMPACT OF MINIMALLY INVASIVE DECOMPRESSION SURGERY ON THE QUALITY OF LIFE OF PATIENTS WITH LUMBAR SPINAL STENOSIS – A 2 YEAR FOLLOW-UP STUDY

Acta Neuropsychologica ◽

10.5604/01.3001.0010.4302 ◽

2017 ◽

Vol 15 (3) ◽

pp. 0-0

Author(s):

Michał Kłosiński ◽

Ewa Kucharska ◽

Brandon Henry ◽

Anna Jarzębska ◽

Bendik Skinningsrud ◽

...

Keyword(s):

Quality Of Life ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Decompression Surgery ◽

Lumbar Region ◽

Sf 36 ◽

Lumbar Spinal ◽

Minimally Invasive Decompression

Background: Lumbar spinal stenosis (LSS) may result in a progressive narrowing of the spinal canal leading to compression of the nerve roots. The advantages of minimally invasive surgical approaches to the lumbar spine have been rigorously evaluated, however, the long-term impact on the health-related quality-of-life (HRQoL) of patients with LSS that have undergone minimally invasive decompression surgery is uncertain. To this end, the aim of our study was to evaluate the impact of this procedure on the HRQoL of patients with LSS. Methods: Enrolled patients were recruited to this prospective study at two orthopedic centers in Krakow, Poland. Patients eligible for inclusion were above 18 years of age, had been qualified for spine surgery of the lumbar region due to either discopathy or non-traumatic spinal stenosis, had uni- or bilateral neurogenic claudication, and verified spinal stenosis. During the interview, each patient completed the Polish version of the SSSQ (P-SSSQ), SF-36, and a demographic data questionnaire. Apart from the preoperative assessment the patients were again approached to fill in the questionnaires 6, 12, 18, and 24 months postoperatively. Results: One hundred and seventy-one consecutive patients with a mean age of 59 years were included in the study. This study found that LSS decompression statistically significantly increases HRQoL in a 2-year observation. There was a significant difference between the preoperative and postoperative SF-36 and P-SSSQ scores. The largest increase in HRQoL is between the preoperative period and 6 months post-op (p<0.0001). Starting from around 18 months post-op, further changes in HRQoL are minimal. Late complications (persistent pain, the need for revision surgery) may decrease HRQoL at around 24 months post-op. Conclusions: Minimally invasive decompression surgery for elderly patients with LSS significantly improves their HRQoL

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The Impact of Lumbar Spinal Stenosis, Knee Osteoarthritis, and Loss of Lumbar Lordosis on the Quality of Life: Findings from the Katsuragi Low Back Pain Study

Spine Surgery and Related Research ◽

10.22603/ssrr.2018-0051 ◽

2019 ◽

Vol 3 (2) ◽

pp. 157-162 ◽

Cited By ~ 4

Author(s):

Yuyu Ishimoto ◽

Mamoru Kawakami ◽

Elizabeth Curtis ◽

Cyrus Cooper ◽

Nicholas C. Harvey ◽

...

Keyword(s):

Quality Of Life ◽

Low Back Pain ◽

Back Pain ◽

Knee Osteoarthritis ◽

Spinal Stenosis ◽

Lumbar Lordosis ◽

Low Back ◽

Lumbar Spinal ◽

The Impact

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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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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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