Mind the gap: symptom relief and mobility recovery after endoscopic lumbar decompression

Lumbar spinal stenosis often limits the ability to stand or walk, impairing daily function. The authors evaluated the impact of endoscopic lumbar decompression on postoperative stepping behavior and surgical satisfaction.

This prospective multicenter cohort study enrolled patients undergoing full-endoscopic lumbar decompression, including lumbar endoscopic unilateral laminotomy for bilateral decompression and interlaminar endoscopic lateral recess decompression, at 7 US centers between November 2022 and March 2025. Activity goals, patient-reported outcome measures (Oswestry Disability Index [ODI], EQ-5D, visual analog scale [VAS], and 3-month surgical satisfaction), health data, and continuous step counts were collected using the SPINEHealthie app. Patients were stratified into tertiles based on average daily step counts during the 30 days preoperatively. Postoperative step counts were similarly categorized at 3, 6, 9, and 12 months to evaluate changes over time. Factors associated with improved postoperative step counts (defined as either a ≥ 20% increase in average daily steps from baseline or maintaining ≥ 6000 steps per day throughout follow-up) were identified using univariate and multivariable logistic regression.

Ninety-six patients were included (mean age 62.3 ± 1.4 years, 35% female, BMI 30.1 ± 0.6). Pain, quality of life, and satisfaction improved significantly after surgery. At 1 year, the mean back pain VAS score decreased from 5.7 ± 0.2 to 2.7 ± 0.4, ipsilateral leg pain from 5.2 ± 0.3 to 2.0 ± 0.4, and contralateral leg pain from 3.2 ± 0.3 to 1.7 ± 0.4 (all p < 0.001). The mean ODI improved from 19.7 ± 0.8 to 10.0 ± 1.4 (p < 0.001). Step counts declined immediately postoperatively, recovered by 1 month (3979 ± 295 steps/day; +3% from baseline, p = 0.53), and increased by 12 months (4507.4 ± 466.6 steps/day; +17%, p < 0.01). Patients demonstrated heterogeneous changes in activity tertiles over time. Compared with the lowest tertile, the highest preoperative steppers had 74% lower odds of postoperative improvement at 6 months (OR 0.26, months 1-9, p < 0.04). Patients achieving meaningful step gains had higher odds of surgical satisfaction (OR 10.06, month 3, p < 0.0069).

Endoscopic lumbar decompression improves pain and disability, whereas mobility gains are modest and dependent on baseline function. Lower baseline function predicts greater improvement, whereas early postoperative increases in walking are strongly associated with satisfaction. These findings highlight the importance of setting realistic expectations with patients regarding postoperative functional recovery, while emphasizing the need for future studies to test whether structured rehabilitation or behavioral interventions can improve mobility.