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Author Spotlight: Scope of LE-ULBD as a Safe, Effective, and Minimally Invasive Approach to Treat Lumbar Spinal Stenosis
Published on: February 9, 2024
The Clinical Status of Patients With Lumbar Spinal Stenosis Reflects Their Individual Decision to Undergo or Defer
Avihai Soroka1, Anat V Lubetzky, Orla Murphy
1From the Spinal Research Laboratory, Department of Physical Therapy, The Stanley Steyer School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel (Soroka, Weisman, and Masharawi), the Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, NY (Lubetzky and Moffat), the Department of Mathematics and Statistics, Dalhousie University, Halifax, Canada (Murphy), the Israel Spine Center, Assuta Hospital, Tel-Aviv, Israel (Ashkenazi and Floman), the Spine Unit, Meir Medical Center, Kfar Saba, Israel (Shabat), and the Department of Orthopedics, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel (Shabat).
Objective:
To evaluate whether functional, clinical, and self-reported tests reflect lumbar spinal stenosis patients' decisions to undergo or defer surgery.
Methods:
Among 108 participants, 77 chose surgery (SG), and 31 opted to wait and see (WaSG) whether they got better spontaneously. Both groups were assessed at baseline (t 0 ) and 3 months (t 1 ), with additional self-reported measures at 6 (t 2 ) and 12 months (t 3 ). Key outcomes included corridor walk distance, chair sit-to-stand repetitions, grip strength, and various pain and disability indices.
Results:
At baseline, SG reported higher leg pain (NPRS-leg: Δ = 1.66, P = 0.002) and poorer functional outcomes across multiple tests. By t 1 , both groups improved in disability, but SG showed greater reductions in the Oswestry Disability Index (Δ = 7.85, P = 0.001) and sustained improvements in leg pain at subsequent assessments. WaSG consistently engaged in more walking (mean Δ = 123.5 minutes, P < 0.001). Regression analyses indicated that surgery status, flexibility, and strength significantly predicted improvements in disability (adjusted R² = 0.296). Logistic regression identified predictors for surgery choice, including biological sex, leg pain intensity, walking performance, and weekly walking hours.
Conclusion:
Functional status, self-reported disability, and fear-avoidance beliefs in lumbar spinal stenosis patients reflect their subjective decision regarding surgery and highlight the importance of baseline leg pain, calf strength, walking-related parameters, and physical function in recovery.
Study Design:
Observational prospective cohort.
