[Long-term results of surgical treatment of lumbar spinal stenosis]

Some discussion remains concerning the quality of the long-term functional outcome after surgical treatment of lumbar spinal stenosis. The purpose of this retrospective observational study was to evaluate outcome ten years after surgical treatment of lumbar spinal stenosis and to determine the rate of reoperation as well as to identify factors influencing outcome at last follow-up.

Between January 1990 and December 1992, 141 patients underwent surgery for lumbar stenosis all were included in present study. Mean follow-up was ten years. At last follow-up, functional signs were assessed with a designated self-administered questionnaire with items for lumbar and radicular pain, signs of radicular ischemia, and patient satisfaction and two visual analog scales for lumbar and radicular pain. Other data recorded included: epidemiological and morphological features of the study population, comorbidities, presence or not of objective neurological signs, anatomy of the stenosis, and results of two self-administered questionnaires on quality of life (SF36) and anxiety-depression (GHA28). Two data analysis methods were applied. The first was a descriptive analysis to quantify the importance of functional signs observed at last follow-up, patient satisfaction, and rate of recurrence as well as reasons for reoperation. The second was a multivariate analysis designed to identify factors influencing the score obtained on the designated stenosis self-administered questionnaire.

Fifteen patients had undergone a revision procedure on the lumbar spine. At last follow-up overall satisfaction was 71%. The best results were obtained for radiculalgia and intermittent neurogenic claudication. Residual lumbalgia was the main complaint at last follow-up. The patient's psychological profile was found to be the predominant factor influencing functional outcome. Other factors having an effect in this population were: reoperation, persistence of objective neurological disorders, degree of comorbidity.

For the majority of patients, surgical treatment of lumbar spinal stenosis provides good long-term results and patient satisfaction. At ten years, the risk of reoperation was 10% in this population. Compared with data in the literature, these results are better than with medical treatment. Surgery enables these patients to have a quality of life similar to an age-matched control population.