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Prognostic factors in lumbar spinal stenosis surgery. A prospective study of imaging- and patient-related factors in 109 patients who were operated on by decompression

Sigmundsson, Freyr Gauti LU ; Kang, Xiao P; Jönsson, Bo LU and Strömqvist, Björn LU (2012) In Acta Orthopaedica 83(5). p.536-542
Abstract
Background and purpose A considerable number of patients who undergo surgery for spinal stenosis have residual symptoms and inferior function and health-related quality of life after surgery. There have been few studies on factors that may predict outcome. We tried to find predictors of outcome in surgery for spinal stenosis using patient- and imaging-related factors. Patients and methods 109 patients in the Swedish Spine Register with central spinal stenosis that were operated on by decompression without fusion were prospectively followed up 1 year after surgery. Clinical outcome scores included the EQ-5D, the Oswestry disability index, self-estimated walking distance, and leg and back pain levels (VAS). Central dural sac area, number of... (More)
Background and purpose A considerable number of patients who undergo surgery for spinal stenosis have residual symptoms and inferior function and health-related quality of life after surgery. There have been few studies on factors that may predict outcome. We tried to find predictors of outcome in surgery for spinal stenosis using patient- and imaging-related factors. Patients and methods 109 patients in the Swedish Spine Register with central spinal stenosis that were operated on by decompression without fusion were prospectively followed up 1 year after surgery. Clinical outcome scores included the EQ-5D, the Oswestry disability index, self-estimated walking distance, and leg and back pain levels (VAS). Central dural sac area, number of levels with stenosis, and spondylolisthesis were included in the MRI analysis. Multivariable analyses were performed to search for correlation between patient-related and imaging factors and clinical outcome at 1-year follow-up. Results Several factors predicted outcome statistically significantly. Duration of leg pain exceeding 2 years predicted inferior outcome in terms of leg and back pain, function, and HRLQoL. Regular and intermittent preoperative users of analgesics had higher levels of back pain at follow-up than those not using analgesics. Low preoperative function predicted low function and dissatisfaction at follow-up. Low preoperative EQ-5D scores predicted a high degree of leg and back pain. Narrow dural sac area predicted more gains in terms of back pain at follow-up and lower absolute leg pain. Interpretation Multiple factors predict outcome in spinal stenosis surgery, most importantly duration of symptoms and preoperative function. Some of these are modifiable and can be targeted. Our findings can be used in the preoperative patient information and aid the surgeon and the patient in a shared decision making process. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
83
issue
5
pages
536 - 542
publisher
Taylor & Francis
external identifiers
  • wos:000310015700017
  • pmid:23083437
  • scopus:84867849979
ISSN
1745-3682
DOI
10.3109/17453674.2012.733915
language
English
LU publication?
yes
id
5932c7d1-c4db-4e85-98a0-023400b6b5c8 (old id 3160544)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/23083437?dopt=Abstract
date added to LUP
2012-11-01 11:15:56
date last changed
2017-10-29 04:00:54
@article{5932c7d1-c4db-4e85-98a0-023400b6b5c8,
  abstract     = {Background and purpose A considerable number of patients who undergo surgery for spinal stenosis have residual symptoms and inferior function and health-related quality of life after surgery. There have been few studies on factors that may predict outcome. We tried to find predictors of outcome in surgery for spinal stenosis using patient- and imaging-related factors. Patients and methods 109 patients in the Swedish Spine Register with central spinal stenosis that were operated on by decompression without fusion were prospectively followed up 1 year after surgery. Clinical outcome scores included the EQ-5D, the Oswestry disability index, self-estimated walking distance, and leg and back pain levels (VAS). Central dural sac area, number of levels with stenosis, and spondylolisthesis were included in the MRI analysis. Multivariable analyses were performed to search for correlation between patient-related and imaging factors and clinical outcome at 1-year follow-up. Results Several factors predicted outcome statistically significantly. Duration of leg pain exceeding 2 years predicted inferior outcome in terms of leg and back pain, function, and HRLQoL. Regular and intermittent preoperative users of analgesics had higher levels of back pain at follow-up than those not using analgesics. Low preoperative function predicted low function and dissatisfaction at follow-up. Low preoperative EQ-5D scores predicted a high degree of leg and back pain. Narrow dural sac area predicted more gains in terms of back pain at follow-up and lower absolute leg pain. Interpretation Multiple factors predict outcome in spinal stenosis surgery, most importantly duration of symptoms and preoperative function. Some of these are modifiable and can be targeted. Our findings can be used in the preoperative patient information and aid the surgeon and the patient in a shared decision making process.},
  author       = {Sigmundsson, Freyr Gauti and Kang, Xiao P and Jönsson, Bo and Strömqvist, Björn},
  issn         = {1745-3682},
  language     = {eng},
  number       = {5},
  pages        = {536--542},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Prognostic factors in lumbar spinal stenosis surgery. A prospective study of imaging- and patient-related factors in 109 patients who were operated on by decompression},
  url          = {http://dx.doi.org/10.3109/17453674.2012.733915},
  volume       = {83},
  year         = {2012},
}