133. How preoperative motor weakness affects the extent of recovery after elective spine surgery in patients with degenerative lumbar spinal stenosis

Abstract

<h3>BACKGROUND CONTEXT</h3> Favorable clinical outcomes have been described for elective spine surgery in patients with LSS. However, the way preoperative motor weakness (MW) affects the patient's health-related quality of life (HRQoL) after surgery is not well understood. <h3>PURPOSE</h3> This study sought to determine how baseline MW affects elective spine surgery in patients with degenerative lumbar spinal stenosis (LSS). <h3>STUDY DESIGN/SETTING</h3> Single center retrospective case series. <h3>PATIENT SAMPLE</h3> This study included 305 surgically treated patients with LSS who had 2-year follow-up (age 71±9 years, male 62%). <h3>OUTCOME MEASURES</h3> Demographic, radiographic, and clinical outcomes were analyzed. <h3>Methods</h3> The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used to assess the HRQoLs at baseline and at 1-year, 2-year, and 3-year postoperation. The HRQoLs were compared between those with or without preop MW. Adjusted multivariate logistic regression analyses (MRAs) were performed to determine whether MW affected HRQoLs. <h3>Results</h3> A total of 116 patients (38%) were categorized as MW+. The patient background including age, sex, presence of degenerative spondylolisthesis, type of surgery, and presence of neurological claudication were similar between the 2 groups. However, the 1-, 2-, and 3-year postoperative VAS of back pain, leg pain, leg numbness, JOABPEQ lumbar function, social life, mental health, and walking ability were all inferior in the MW+ group, whereas a similar percentage of patients achieved a minimum clinically important difference in all subdomains at 3 years. The adjusted MRA showed that having ≥2 muscles with MW, and severity of MW (MMT grade) were independent risk factors for both difficulty climbing stairs and walking >15 minutes (muscles with MW≥2; stair climbing: OR 6.4[2.3-17.4], walking: OR 3.2[1.4-7.3], severity of MW; stair climbing: OR 2.5[1.4-4.4], walking:OR 2.2[1.3-3.7]). <h3>Conclusions</h3> The patients with baseline MW had inferior HRQoL for up to 3 years compared to that of those without MW; however, the amount of improvement in HRQoL was comparable. Timely follow-up is important to determine the deterioration of motor function. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.