The Implication of Preoperative Central Stenosis on Patient-Reported Outcomes After Lumbar Decompression Surgery

Abstract

To assess the impact of central stenosis severity on patient-reported outcomes after lumbar decompression. Patient diagnosis, demographics, and surgical characteristics were collected via query search and manual chart review of electronic medical records. The inclusion criteria were posterior lumbar decompressions from 2014-2020, with accessible MRI reports. As previously validated by Lee et al., central stenosis was determined on magnetic resonance imaging and graded as none, mild, moderate, or severe. Patients were dichotomized into two groups to improve statistical power for comparisons: none or mild central stenosis and moderate or severe central stenosis. PROMs were compared between cohorts at one year postoperatively. Statistical significance was set at p < 0.05. On bivariant analysis, no significant differences were noted between cohorts with regard to preoperative, one-year postoperative, and ΔPROMs. In addition, no significant difference in the number of patients attaining minimal clinically important difference (MCID) for each PROM was noted between cohorts. With the exception of MCS-12, all intragroup preoperative to postoperative PROMs indicated significant improvement (all p<0.05) after lumbar decompression surgery. Multivariate regression identified moderate or severe central canal stenosis as a significant independent predictor of improvement in VAS-back (estimate=-1.464, p=0.045). We demonstrate that patients with moderate or severe central spinal stenosis may have more improvement in back pain than those with mild or no central stenosis after lumbar spine decompression surgery.