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Predictors of surgical outcome in degenerative lumbar spinal stenosis
J N Katz1, G Stucki, S J Lipson
1Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA. jnkatz@bics.bwh.harvard.edu
Study Design:
A prospective, observational study.
Objectives:
To identify outcome predictors of surgery for degenerative lumbar spinal stenosis.
Summary Of Background Data:
Degenerative lumbar spinal stenosis is the most frequent indication for spine surgery in the elderly. More than 25% of surgical patients have a poor outcome, yet little is known about factors that predict the outcome of surgery.
Methods:
Surgery was performed on 199 patients with degenerative lumbar spinal stenosis, and they were observed for 2 years after surgery in four referral centers. Surgery consisted of decompressive laminectomy with or without arthrodesis. Outcomes included validated measures of symptom severity, walking capacity, and satisfaction with the results of surgery. Potential predictors of outcome included sociodemographic factors and physical examination, as well as radiographic, psychological, social, and clinical history variables.
Results:
The proportion of patients with severe pain decreased from 81% before surgery to 31% by 2 years afterward. The most powerful preoperation predictor of greater walking capacity, milder symptoms, and greater satisfaction was the patient's report of good or excellent health before surgery. Low cardiovascular comorbidity also predicted a favorable outcome.
Conclusions:
Patient's assessments of their own health and comorbidity are the most cogent outcome predictors of surgery for spinal stenosis.