Surgery For Lumbar Spinal Stenosis Research Articles

Effectiveness of Surgery for Degenerative Lumbar Spinal Stenosis: A Systematic Review

Effectiveness of Surgery for Degenerative Lumbar Spinal Stenosis: A Systematic Review

Central sensitization adversely affects quality of recovery following lumbar decompression surgery

BackgroundCentral sensitization (CS) is defined as increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. The CS phenomenon is caused by continuous, intense nociceptor inputs triggering a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in the central nociceptive pathway. Most patients undergoing surgery for lumbar spinal stenosis (LSS) experience symptoms for more than three months; therefore, it is possible that CS is associated with postoperative symptoms of LSS. The aim of this study was to clarify the influence of CS in patients who underwent surgery for LSS. MethodsWe used the Central Sensitization Inventory (CSI) to evaluate CS preoperatively. Clinical and neurological symptoms were assessed before surgery and three months after surgery using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI). To evaluate the correlation between the preoperative CSI score and each parameter of the JOA-BPEQ before and three months after surgery, a Pearson correlation coefficient was used. We also evaluated the correlation between preoperative CSI and improvement scores for each parameter of the JOA-BPEQ for surgery. Similarly, the ODI was assessed. ResultsThis study included 118 patients. After surgery, the parameters of lumbar function disorder, social life function disorder, and mental health disorder revealed a statistically significant relationship (r = −0.289, −0.0354, and −0.493, respectively). There was no significant correlation between CSI and improvement scores of the JOA-BPEQ. The ODI assessment after surgery revealed a statistically significant relationship (r = 0.344). There was no significant correlation between the CSI and ODI improvement scores. ConclusionThis study showed that the severity of the CSI influenced the postoperative outcomes, and that surgical treatment improved the symptoms of LSS regardless of the occurrence of CS preoperatively.

The Concerns and Experiences of Patients With Lumbar Spinal Stenosis Regarding Prehabilitation and Recovery After Spine Surgery: A Qualitative Study

To improve our understanding of patients' perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences. Qualitative research with semi-structured interviews. General community. Individuals who received (N=10) and who did not receive (N=15) prehabilitation before LSS surgery were recruited at the 6-month postoperative follow-up (8 females; average age: 67.7±6.7 years) by purposive sampling. Additionally, 1 participant invited her daughter to accompany her in an interview. Not applicable. Concerns and experiences of patients with LSS regarding prehabilitation and recovery after spine surgery. Thematic analysis was conducted to identify 4 themes inductively: (1) sources of information about LSS surgery; (2) factors affecting the surgical decision-making; (3) attitudes toward prehabilitation; and (4) postoperative recovery. All participants desired to have more preoperative education to inform their surgical decision-making. There were mixed opinions regarding the perceived benefits of prehabilitation because some individuals hesitated to participate in prehabilitation because of their symptoms, or the cost or time of traveling. Many participants expected some or even complete relief of LSS-related symptoms after surgery. However, not all participants experienced the expected postoperative improvements. Some participants only experienced temporary symptomatic relief, while others experienced new postoperative symptoms. Patients generally found that postoperative exercises taught by physiotherapists were useful although their compliance decreased over time. Our study highlights the need for better preoperative LSS education. Because face-to-face prehabilitation or postoperative rehabilitation may not be feasible for all patients, future studies should explore whether online-based prehabilitation or postoperative rehabilitation may benefit certain patient subgroups.

A cost-utility analysis between decompression only and fusion surgery for elderly patients with lumbar spinal stenosis and sagittal imbalance

Lumbar spinal stenosis (LSS) and sagittal imbalance are relatively common in elderly patients. Although the goals of surgery include both functional and radiological improvements, the criteria of correction may be too strict for elderly patients. If the main symptom of patients is not forward-stooping but neurogenic claudication or pain, lumbar decompression without adding fusion procedure may be a surgical option. We performed cost-utility analysis between lumbar decompression and lumbar fusion surgery for those patients. Elderly patients (age > 60 years) who underwent 1–2 levels lumbar fusion surgery (F-group, n = 31) or decompression surgery (D-group, n = 40) for LSS with sagittal imbalance (C7 sagittal vertical axis, C7-SVA > 40 mm) with follow-up ≥ 2 years were included. Clinical outcomes (Euro-Quality of Life-5 Dimensions, EQ-5D; Oswestry Disability Index, ODI; numerical rating score of pain on the back and leg, NRS-B and NRS-L) and radiological parameters (C7-SVA; lumbar lordosis, LL; the difference between pelvic incidence and lumbar lordosis, PI-LL; pelvic tilt, PT) were assessed. The quality-adjusted life year (QALY) and incremental cost-effective ratio (ICER) were calculated from a utility score of EQ-5D. Postoperatively, both groups attained clinical and radiological improvement in all parameters, but NRS-L was more improved in the F-group (p = 0.048). ICER of F-group over D-group was 49,833 US dollars/QALY. Cost-effective lumbar decompression may be a recommendable surgical option for certain elderly patients, despite less improvement of leg pain than with fusion surgery.

Another perspective on lumber spinal stenosis treatment: Should exercise be added to pre-surgical treatment?

Background/Aim: Lumbar spinal stenosis (LSS) is a disease that affects the quality of life of elderly individuals. Most patients undergoing surgery for lumbar spinal stenosis try physical therapy before opting to undergo surgery. The effect of pre-surgical exercise treatment is unclear. This study aimed to examine the effect of pre-surgical exercise treatment on functionality, quality of life, and balance. Methods: Patients between the ages of 40 and 70 who were scheduled for surgery based on a diagnosis of LSS were included in this cross-sectional study. The patients were randomly divided into two groups for which exercise therapy was added to the first group before the surgery, and the control group followed in the normal process. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Beck Depression and Anxiety Inventory (BDI and BAI, respectively), Berg Balance Scale (BBS), static and dynamic balance measurements holding hands on and off on the balance device (SBHON, DBHON, DBHOFF) and the SF-36 quality of life scale tests were administered pre-operatively and eight weeks post-operatively, and the results were compared between the two groups that did and did not exercise before surgery. Results: Post-operative SBHON values were found to be significantly lower in the exercise group compared to the other group (P < 0.001). While no differences between pre- and post-operative BBS, DBHON, and DBHOFF values in the non-exercising group were detected, a favorable significant difference in the exercising group was found (all P < 0.001). Conclusion: The addition of pre-surgical exercise therapy to patients can lead to improvements in the success of surgery and contribute to the functionality of patients with LSS diagnosis.

The serpentine pattern on MRI as an early prognostic factor after fusion for lumbar spinal stenosis.

This study aimed to determine the relationship between the serpentine pattern nerve roots (SNR) and prognosis after lumbar fusion for lumbar spinal stenosis (LSS) by comparing clinical outcomes in patients with or without a serpentine pattern. LSS patients with neurological symptoms often present with SNRs. Several studies have shown that LLS symptoms are worse in patients with SNRs. However, the relationship between SNR and outcome after spinal fusion surgery has not yet been established. A total of 332 patients who underwent spinal fusion surgery between January 1, 2010, and December 31, 2019, were enrolled. Patients were divided into those with a serpentine pattern (S group) and those without a serpentine pattern (N group). The prognosis of the 2 groups was compared using visual analog scale (VAS), Oswestry disability index, claudication distance, medication dose for leg dysesthesia, and glucose tolerance. A total of 113 patients had a serpentine pattern, while the remaining 219 did not. Symptom duration and presence of diabetes mellitus were significantly different between the 2 groups (N = 25.4, S = 32.6, P < .05). Changes in the VAS score for lower extremity pain between the 2 groups at 1 year after surgery showed that patients without a serpentine pattern had significantly better outcomes than those with a serpentine pattern (N: 2.7 ± 1.1 vs S: 4.1 ± 1.3; P < .001), despite the score change at 1 month showing no difference (N: 3.5 ± 0.9 vs S: 3.8 ± 1.0; P = .09). SNRs on MRI are more prevalent in diabetic patients and are a negative prognostic factor in lumbar fusion surgery for LSS. Our insights may help physicians decide the optimal surgical plan and predict the postoperative prognosis of patients with LSS.

Incidental dural tears associated with worse clinical outcomes in patients operated for lumbar spinal stenosis

Study designRetrospective cohort study.ObjectiveIncidental dural (ID) tear is a common complication of spine surgery with a prevalence of 4–10%. The association between ID and clinical outcome is uncertain. Former studies found only minor differences in Oswestry Disability Index (ODI). We aimed to examine the association of ID with treatment failure after surgery for lumbar spinal stenosis (LSS).MethodsBetween 2007 and 2017, 11,873 LSS patients reported to the national Norwegian spine registry (NORspine), and 8,919 (75.1%) completed the 12-month follow-up. We used multivariate logistic regression to study the association between ID and failure after surgery, defined as no effect or any degrees of worsening; we also compared mean ODI between those who suffered a perioperative ID and those who did not.ResultsThe mean (95% CI) age was 66.6 (66.4–66.9) years, and 52% were females. The mean (95% CI) preoperative ODI score (95% CI) was 39.8 (39.4–40.1); all patients were operated on with decompression, and 1125 (12.6%) had an additional fusion procedure. The prevalence of ID was 4.9% (439/8919), and the prevalence of failure was 20.6% (1829/8919). Unadjusted odds ratio (OR) (95% CI) for failure for ID was 1.51 (1.22–1.88); p < 0.001, adjusted OR (95% CI) was 1.44 (1.11–1.86); p = 0.002. Mean postoperative ODI 12 months after surgery was 27.9 for ID vs. 23.6 for no ID.ConclusionWe demonstrated a significant association between ID and increased odds for patient-reported failure 12 months after surgery. However, the magnitude of the detrimental effect of ID on the clinical outcome was small.

Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review

In recent years, unilateral biportal endoscopic spinal surgery has been used for the treatment of lumbar spinal stenosis with good results. Some investigators counted the total incidence of complications in unilateral biportal endoscopic surgery for lumbar spinal stenosis, but none have analyzed the incidence of specific complications. The present study further counted the incidence of specific complications and gave the possible causes of the complications. English databases including PubMed were searched to collect relevant literature on unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis. The inquiry period is from January 1, 2015, to July 1, 2022. The literature was screened, information extracted, and risk of bias evaluated by the researchers, followed by Meta analysis using R4.2.1 and RStudio statistical software. In total, we included 14 studies involving 707 patients. The included studies were retrospective case series, The results of the single-arm rate meta-analysis showed that the total complication rate of unilateral biportal endoscopic surgery treatment of lumbar spinal stenosis was 8.1% (95% confidence interval [CI] [0.060; 0.103]); of which, the highest incidence of dural tear was 4.5% (95% CI [0.030; 0.064]), the incidence of symptomatic postoperative spinal epidural hematoma was approximately 1.1% (95% CI [0.001; 0.027]), the incidence of incomplete decompression was 2.0% (95% CI [0.007; 0.038]), the incidence of transient palsy was 2.6% (95% CI [0.005; 0.057]). The incidence of total complications of unilateral biportal endoscopic surgery for lumbar spinal stenosis was 8.1%, dural tear remained a major complication with an incidence of 4.5%, incomplete decompression was 2.0%, transient palsy was 2.6%, and, unexpectedly, symptomatic postoperative spinal epidural hematoma was only 1.1%.

Preliminary results of biportal endoscopic lumbar interbody fusion, decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability

Objectives: To evaluate the preliminary clinical outcomes of biportal endoscopic lumbar interbody fusion (BE-LIF), decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability. Methods: The data of 9 patients with single-level lumbar spinal stenosis who underwent BE-LIF, decompression and pedicle screw insertion assisted with biportal endoscopy in Xinjiang Production and Construction Corps Hospital from March 1st 2022 to April 30th 2022 were analyzed retrospectively. The visual analogue scales (VAS) for pain in back and legs, and the Oswestry disability index (ODI) of all the patients were collected before operation, on the third day after operation and at the last follow-up. Moreover, the operation time, intra-operation blood loss, radiation shots for pedicle screw insertion, post-operation drainage and ambulation time were recorded. The screw position was checked with CT after the operation. Results: All the patients were female with a mean age of (70.3±8.4) years (ranged 56-84 years); the patients were followed-up for 12-16 weeks. All 9 patients had good clinical results. The VAS scores for back pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(2.9±0.6), (1.8±0.4) vs (6.4±1.1) points, both P<0.05]. The VAS scores for leg pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(1.9±0.3), (1.4±0.5) vs (7.3±1.6) points, P<0.05]. The ODI scores at last follow-up was significantly lower than that before the operation ((24.0%±6.5% vs 55.7%±12.8%, P<0.05). The intra-operative blood loss was (177±103) ml, the drainage amounts post-operation was (122±56) ml, the operation time was (207.8±32.7)min, the ambulation time was (2.3±0.5) days. The total radiation shots for pedicle screw insertion were 20-42 times, the average radiation shots per screw was (6.9±1.5) times. No severe complications or adverse events occurred. No nerve root injury or dural tear occurred in the operation, and no revision surgery needed. Conclusions: The pedicle screw insertion assisted with biportal endoscopic technique can decrease the radiation exposure with good feasibility and safety during the BE-LIF. The BE-LIF combined with the pedicle screw insertion assisted with biportal endoscopy is an effective and safe surgery for lumbar spinal stenosis with good early results.

Predictors for failure after surgery for lumbar spinal stenosis: a prospective observational study

Background/contextSome patients do not improve after surgery for lumbar spinal stenosis (LSS), and surgical treatment implies a risk for complications and deterioration. Patient selection is of paramount importance to improve the overall clinical results and identifying predictive factors for failure is central in this work. PurposeWe aimed to explore predictive factors for failure and worsening after surgery for LSS. Study design /settingRetrospective observational study on prospectively collected data from a national spine registry with a 12-month follow-up. Patient sampleWe analyzed 11,873 patients operated for LSS between 2007 and 2017 in Norway, included in the Norwegian registry for spine surgery (NORspine). Twelve months after surgery, 8919 (75.1%) had responded. Outcome measuresOswestry Disability Index (ODI) 12 months after surgery. MethodsPredictors were assessed with uni- and multivariate logistic regression, using backward conditional stepwise selection and a significance level of 0.01. Failure (ODI>31) and worsening (ODI>39) were used as dependent variables. ResultsMean (95%CI) age was 66.6 (66.4–66.9) years, and 52.1% were females. The mean (95%CI) preoperative ODI score was 39.8 (39.4–40.1). All patients had decompression, and 1494 (12.6%) had an additional fusion procedure. Twelve months after surgery, the mean (95%CI) ODI score was 23.9 (23.5–24.2), and 2950 patients (33.2%) were classified as failures and 1921 (21.6%) as worse. The strongest predictors for failure were duration of back pain > 12 months (OR [95%CI]=2.24 [1.93–2.60]; p<.001), former spinal surgery (OR [95%CI]=2.21 [1.94–2.52]; p<.001) and age>70 years (OR (95%CI)=1.97 (1.69–2.30); p<.001). Socioeconomic variables increased the odds of failure (ORs between 1.36 and 1.62). The strongest predictors for worsening were former spinal surgery (OR [95%CI]=2.04 [1.77–2.36]; p<.001), duration of back pain >12 months (OR [95%CI]=1.83 [1.45–2.32]; p<.001) and age >70 years (OR [95%CI]=1.79 [1.49–2.14]; p<.001). Socioeconomic variables increased the odds of worsening (ORs between 1.33–1.67). ConclusionsAfter surgery for LSS, 33% of the patients reported failure, and 22% reported worsening as assessed by ODI. Preoperative duration of back pain for longer than 12 months, former spinal surgery, and age above 70 years were the strongest predictors for increased odds of failure and worsening after surgery.

Efficacy of the five-item modified frailty index for predicting a poor prognosis in patients undergoing posterior lumbar interbody fusion surgery for lumbar spinal stenosis

Objective: This study aimed to determine whether preoperative frailty assessed using the five-item modified frailty index (mFI-5) in patients undergoing posterior lumbar interbody fusion for lumbar spinal stenosis can predict poor patient outcomes.Methods: We retrospectively included 192 patients aged 18 years or older who were diagnosed with lumbar spinal stenosis and underwent posterior lumbar interbody fusion at a single hospital between March 2009 and February 2021. We calculated mFI-5 scores for these patients based on the following five comorbidities: (1) hypertension requiring medication, (2) diabetes mellitus, (3) history of chronic obstructive pulmonary disease or pneumonia, (4) history of congestive heart failure in the 30 days before surgery, and (5) partially or totally dependent functional health status at the time of surgery. The patients were categorized into three groups according to their mFI-5 scores, and these groups were analyzed. A P&lt;0.05 was considered statistically significant in all analyses.Results: Length of hospital stay (LOS) was significantly associated with mFI-5 score (β=0.196, P=0.008), age (β=0.112, P=0.159), and surgical level (β=0.238, P&lt;0.001). In patients with fusion at one or two levels, mFI-5 score showed the greatest association with LOS (β=0.188, P=0.016), followed by sex (β=0.137, P=0.065) and the number of fused segments (β=0.137, P=0.065).Conclusion: Frailty may not be an independent predictor, but it has significant predictive power for LOS in patients undergoing posterior lumbar interbody fusion for lumbar spinal stenosis, especially in patients undergoing fusion at one or two levels.

Usefulness of preoperative Short Form-36 Mental Component Score as a prognostic factor in patients who underwent decompression surgery for degenerative lumbar spinal stenosis.

Physical factors such as frequency of low back pain, sensory abnormalities in the lower extremities, smoking history before surgery, and preoperative mental health status as predictors of operative outcomes have been growing as areas of interest in the field of degenerative lumbar spinal stenosis (DLSS). This study aimed to investigate the correlation between the preoperative Short Form-36 Mental Component Score (SF-36 MCS) and long-term prognosis after decompression surgery for DLSS. In total, 198 patients were enrolled in this study. The Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ) were used to evaluate spinal functional outcomes. The SF-36 questionnaire was used and analyzed by classifying it into physical component score (PCS) and mental component score (MCS). The SF-36 MCS was divided into role limitations caused by emotional problems, social functioning, vitality, and emotional well-being. In the correlation between preoperative MCS and ODI improvement, the r value was −0.595 (P < .05) at 12 months postoperatively. ODI improvement at 12 months after decompression surgery showed a statistically significant and strong negative correlation with preoperative MCS. In the correlation between preoperative MCS and RMDQ improvement, the r value was −0.544 (P < .05) at 12 months postoperatively. Therefore, RMDQ improvement 12 months after decompression surgery showed a strong negative correlation with preoperative MCS. Regarding the correlation between preoperative MCS and SF-36 PCS improvement, the r values were 0.321 (P < .05) at 6 months postoperatively and 0.343 (P < .05) at 12 months postoperatively. Therefore, SF-36 PCS improvement at 6 and 12 months after decompression surgery showed a strong positive correlation with preoperative SF-36 MCS scores. Preoperative SF-36 MCS is a factor that can predict the prognosis of patients who underwent decompression surgery for lumbar spinal stenosis for at least 1 year postoperatively.

Efficacy and Safety of Microscopic Bilateral Decompression with Unilateral Laminectomy in Geriatric Lumbar Spinal Stenosis Surgery

Efficacy and Safety of Microscopic Bilateral Decompression with Unilateral Laminectomy in Geriatric Lumbar Spinal Stenosis Surgery

Physical Inactivity Before Surgery for Lumbar Spinal Stenosis Is Associated With Inferior Outcomes at 1-Year Follow-Up: A Cohort Study.

Lumbar spinal stenosis (LSS) is a common disorder in older people. Inactivity secondary to the disease state can further increase LSS symptoms. Initial care includes physiotherapy to relieve symptoms and optimize patient function and quality of life. It is currently unclear whether inactivity before surgery for LSS is associated with postoperative outcomes. Our aim was to investigate associations between self-reported exercise before LSS surgery and self-reported outcomes at 1-year follow-up. Using a retrospective cohort study design, prospective data were collected from the National Swedish Register for Spine Surgery (Swespine) between September 2006 and December 2012: 11,956 patients diagnosed with LSS completed the 1-year follow-up. The primary outcome measure was the Oswestry Disability Index (ODI). Secondary outcome measures were back and leg pain reported on a visual analog scale (VAS). The independent variable was dichotomized into no regular exercise (NRE) and regular exercise (RE). Adjusted analysis of covariance models were used to analyze differences in outcome improvement between the NRE and RE groups. The mean improvement in the ODI was 15.9 (95% CI, 15.5-16.3) in the NRE group and 19.2 (95% CI, 18.5-19.8) in the RE group (P < 0.001). Improvement in back pain (P < 0.001) and leg pain (P < 0.001) were also inferior in the NRE group compared to the RE group. The NRE group improved 21.8 (95% CI, 21.2-22.5) units in back pain and 28.8 (95% CI, 28.1-29.5) in leg pain on the VAS compared to 25.2 (95% CI, 24.2-26.3) units in back pain and 32.5 (95% CI, 31.3-33.6) in leg pain in the RE group. Inactivity defined as self-reported NRE before surgery for LSS is associated with worse outcomes 1-year postsurgery compared to patients reporting RE. This study is relevant to currently practicing spinal surgeons and spine physiotherapists.

P93. The effect of a postoperative epidural hematoma following lumbar spinal stenosis surgery

P93. The effect of a postoperative epidural hematoma following lumbar spinal stenosis surgery

120. The clinical and operative impact of lumbar epidural steroid injections prior to spine surgery for lumbar spinal stenosis

<h3>BACKGROUND CONTEXT</h3> Lumbar spinal stenosis is a common finding in the adult population. Lumbar epidural steroid injections (ESIs) are often used in management of this condition, with conflicting evidence regarding their efficacy. Previous research has suggested a negative impact of ESIs on the operative times and postoperative outcomes when ESIs are administered preoperatively prior to spine surgery in this population. Our retrospective study was performed to gain greater insight into the impact of preoperative ESIs on postoperative outcomes following spine surgery in management of lumbar stenosis. <h3>PURPOSE</h3> Our objective is to determine how preoperative ESIs impact postoperative outcomes following spine surgery in management of lumbar stenosis. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort involving patients who underwent surgical management of lumbar stenosis. Data for patients with preoperative ESI was compared to those without preoperative ESI administration. <h3>PATIENT SAMPLE</h3> Patient data for this retrospective cohort was retrieved solely from a patient database of a medical institution in north Texas, US. Patients were included in the study if they underwent surgical management of lumbar spinal stenosis between January 2016 and December 2020. The inclusion criteria required an active diagnosis of lumbar spinal stenosis. Patients who received an ESI within three months prior to the spine surgery were included in the "ESI" group, while those who did not receive a lumbar ESI within three months prior to the spine surgery were included in the "Non-ESI" group. <h3>OUTCOME MEASURES</h3> Primary outcome measures were ODI (Oswestry Disability Index) back, NDI (Neck Disability Index) back, VAS (Visual Analog Scale) leg pain, VAS back pain, PROMIS (Patient-Reported Outcomes Measurement Information System) pain, PROMIS pain interference, PROMIS satisfaction, PROMIS physical function at time of spine surgery (baseline) and at three months after surgery. <h3>METHODS</h3> This study was conducted at a medical institution in north Texas, US, utilizing the institution's spine center database. The institutional review board approved the standardized protocol. This study included a retrospective cohort. All results were collated on a Microsoft Excel file as retrieved from a patient registry of a medical institution in north Texas based on exclusion and inclusion criteria above. Statistical analysis was performed using IBM SPSS software, with t-test and ANOVA used to determine significance. P-value less than 0.05 was considered statistically significant. <h3>RESULTS</h3> Patients receiving an ESI in the preoperative period had shorter operative times (ESI 157 minutes vs Non-ESI 187 minutes, p=.10) during spine surgery than did patients in the Non-ESI group. Both ESI and Non-ESI groups showed significant improvements in VAS leg, VAS back, ODI and PROMIS pain scores at three months after surgery, with the ESI group showing a significantly larger improvement compared to the Non-ESI group in PROMIS pain scores. <h3>CONCLUSIONS</h3> Regardless of preoperative ESI administration, this study demonstrated improvement in pain and disability scores in the postoperative period following surgical management of lumbar stenosis. Patients who received ESI in the preoperative course had shorter operative times and greater improvements in PROMIS pain scores in the postoperative course compared to those who did not receive ESI. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial

PurposeTo investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS).MethodsThe NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to ≥ 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients’ gender, age, smoking status and BMI.ResultsThe primary analysis showed that severe disc degeneration (Pfirrmann score 4–5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations.ConclusionSevere disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.

Multilevel Decompression Surgery for Degenerative Lumbar Spinal Canal Stenosis Is Similarly Effective With Single-level Decompression Surgery.

Retrospective case series. The purpose of this study was to investigate the outcome of multilevel posterior decompression surgery for degenerative lumbar spinal stenosis compared with single-level surgery. The clinical outcomes of multilevel decompression surgery are still controversial because previous studies have not been designed to randomize or adjust the patient background. A retrospective review of prospectively collected data from 659 surgically treated lumbar spinal stenosis patients with a minimum 2-year follow-up was performed. Among them, we compared baseline and 2-year postoperative patient-reported outcomes (PROs) including the Visual Analog Scale and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores of 122 patients who underwent three or more levels of surgery (M group) and 304 patients who underwent single-level surgery (S group). Further analyses were performed of 116 paired patients from both groups who were propensity score matched by age and baseline PROs. The number of perioperative complications including extradural hematoma, surgical site infection, and spinal fluid leakage [M vs. S: 10 (8%) vs. 19 (6%), P =0.47], and frequency of revision surgery [5 (4%) vs. 23 (8%), P =0.10] were similar between the two groups. In the analysis of propensity score-matched patients, there were comparable improvements in the Visual Analog Scale score for lower back pain (2.6 vs. 2.4, P =0.55), buttock-leg pain (3.1 vs. 3.4, P =0.48), and buttock-leg numbness (2.9 vs. 2.9, P =0.77) in both groups. There were also similar improvements in the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores including lower back pain, lumbar function, walking ability, and mental health domains, except for the social life function domain (20.7±26.5 vs. 28.0±27.5, P =0.04). Despite the longer surgical time and a larger volume of estimated blood loss, multilevel decompression surgery showed similar improvement to that of single-level surgery in terms of recovery of PROs and frequency of revision surgery. Multilevel decompression surgery provides good clinical outcomes with acceptable complication and revision rates when selecting appropriate patient and spinal levels.

Relationship between changes in physical function parameters and Roland-Morris disability questionnaire score after decompression surgery for lumbar spinal canal stenosis.

ABSTRACTAlthough decompression surgery for lumbar spinal canal stenosis (LSS) improves leg symptoms, low back pain (LBP), and disability, the factors related to the improvement of subjective disability have not been studied sufficiently. The purpose of the study was to clarify the relationship between subjective disability and objective physical function parameters. A total of 51 patients who underwent decompression were included and evaluated preoperatively and 6 and 12 months postoperatively. Patient-reported outcomes related to activity limitation due to LBP were evaluated using Roland–Morris disability questionnaire (RDQ) and VAS (Visual Analog Scale). Physical function was assessed using 6-min walk distance (6MWD) and trunk muscle strength. Univariate analysis and multivariable linear regression analysis were performed to identify significant factors for RDQ score change. The 6- and 12-month postoperative RDQ scores, VAS scores, and trunk extensor strength significantly improved relative to the preoperative values. In the univariate analysis, age, changes in VAS (LBP, leg pain, and numbness) scores, and change in 6MWD were associated with the RDQ score change (p < 0.05). Multivariable linear regression showed that 6MWD changes were significantly associated with RDQ score changes, explaining 41% of the variance in the RDQ score change. This study showed the change in 6MWD was significantly associated with the RDQ score change. Our results suggest that improving 6MWD may reduce disability in activities of daily living.

Validation of a Model Predicting That Physical Activities Improve Health-Related Quality of Life in Older Japanese Adults with Pain, Dysesthesia, and Kinesiophobia after Lumbar Surgery: Structural Equation Modeling

Objectives This study assessed the validity of a hypothesized model predicting that physical activity improves health-related quality of life (HRQOL) in older Japanese adults with pain, dysesthesia, and kinesiophobia following lumbar surgery. Methods We included 431 elderly patients who underwent surgery for lumbar spinal stenosis at two hospitals. The frequency of physical activity, pain, dysesthesia, kinesiophobia (somatic focus and activity avoidance), and HRQOL were investigated using a questionnaire. Missing values were complemented by the stochastic regression imputation. We constructed the following model. (i) physical activity affects pain, dysesthesia, and kinesiophobia. (ii) pain, dysesthesia, and kinesiophobia separately affect HRQOL. This hypothetical model was tested by structural equation modeling. The model was improved based on a modified index. Results Of the 431 respondents, 297 (median age 72 years, range 65–91 years; 158 men and 139 women) were analyzed (68.9%). The fit of the model improved based on the modification index and was acceptable comparative fit index, 0.948; Tucker–Lewis index, 0.919; root mean square error of approximation, 0.048 (90% confidence interval, 0.026–0.069), and standardized root mean square residual (0.046). The paths by which physical activities reduced pain or dysesthesia (standardized pass coefficients, −0.406) and somatic focus (−0.301) and consequently improved HRQOL were significant (pain/dysesthesia, −0.684; somatic focus, −0.218). Discussion. Our hypothesized model predicting that physical activity improves HRQOL in terms of pain, dysesthesia, and kinesiophobia in older Japanese adults after lumbar surgery was validated using cross-sectional data. Interventional studies on physical activity based on this model are required to establish the model.