Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis

Background context: Lumbar spinal stenosis is now the most common and fastest growing reason for spinal surgery in adults older than 65 years. There are not yet clearly identified preoperative predictive factors for postoperative clinical outcome. We have previously reported on the clinical outcome of patients treated operatively and nonoperatively.

Purpose: The purpose of this study was to identify independent predictors of clinical outcome in our operative group to guide management in future patients.

Study design/setting: This is a prospective nonrandomized cohort study done in a university center providing secondary and tertiary care.

Patient sample: Ninety-four consecutive patients were evaluated.

Outcome measures: We used a validated patient-oriented disability questionnaire.

Methods: We evaluated patients treated operatively for lumbar spinal stenosis. Ninety-four patients were treated surgically. Clinical outcomes were measured using the modified Roland-Morris questionnaire with 2-year follow-up.

Results: Patients treated surgically had significant improvement at 2-year follow-up. Higher values of body mass index and a history of psychiatric disease were factors associated with a worse outcome, whereas those with more preoperative disability had a better outcome. Age, gender, cardiovascular or musculoskeletal comorbidities, duration of symptoms for more than 1 year, multiple-level decompression, spinal fusion, history of neurogenic claudication, symptomatic lumbosacral extension, subjective numbness or weakness, and objective decrease in sensation or reflex abnormalities were not predictive of outcome.

Conclusions: On average, patients who choose to have surgery will have improvement. However, not all patients having surgery will note improvement, and there are factors predictive for outcome.