Associations between spinal deformity and outcomes after decompression for spinal stenosis

Area of Science:

• Orthopedics
• Neurosurgery
• Radiology

Background:

• Preoperative degenerative scoliosis is often linked to unfavorable outcomes in spinal stenosis surgery.
• Limited and conflicting data exist regarding the impact of increased olisthesis post-laminectomy on surgical outcomes for spinal stenosis.

Purpose of the Study:

• To investigate the association between radiographic parameters, specifically scoliosis and olisthesis, and surgical outcomes in patients with degenerative spinal stenosis.

Main Methods:

• A prospective observational study involving 90 patients undergoing surgery for degenerative spinal stenosis.
• Radiographs were analyzed pre- and post-surgery for scoliosis and changes in olisthesis by blinded reviewers.
• Patient-reported outcomes, including pain, walking capacity, and satisfaction, were collected via questionnaires and analyzed using correlation and regression models.

Main Results:

• Preoperative scoliosis was associated with less improvement in back pain at 6 and 24 months post-surgery.
• An increase in olisthesis post-surgery showed a trend towards greater improvement in lower extremity pain and walking capacity.
• Multivariable analysis indicated no significant association between increased olisthesis and improved outcomes when controlling for confounders.

Conclusions:

• Preoperative scoliosis is associated with less favorable outcomes after decompression for degenerative lumbar spinal stenosis.
• Increases in olisthesis following surgery for spinal stenosis are generally well-tolerated and do not appear to lead to unfavorable results.
• Minor post-operative olisthesis increases may even correlate with a trend toward better patient outcomes.