Syddansk Universitet Patient are satisfied one year after decompression surgery for lumbar spinal stenosis

INTRODUCTION: Lumbar spinal stenosis (LSS) is a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain. The syndrome is associ­ ated with diminished space available for the neural and vas­ cular elements in the lumbar spine. LSS is typically seen in elderly patients, its prevalence is estimated to be 47% in people over the age 60 years. LSS is the most common rea­ son for spine surgery in Denmark and the number of sur­ gical procedures is likely to increase due to demographic changes. The purpose of this study was to evaluate the pa­ tient­reported outcomes and perioperative complications of spinal decompression surgery in LSS patients. METHODS: This study is a retrospective study based on pro­ spectively collected data from 3,420 consecutive patients with clinical and magnetic resonance imaging confirmed LSS. Patients were treated with posterior decompression surgery without fusion. Data were obtained from the Dane­ Spine register and collected pre­ and post­operatively after a minimum interval of one year. The outcome measures were Oswestry Disability Index (ODI), European Quality of Life 5D (EQ­5D), visual analogue score (VAS), 36­Short Form Mental Component Summary (MCS), 36­Short Form Phys­ ical Component Summary (PCS) and self­reported walking distance. RESULTS: Of 3,420 cases enrolled, 2,591 (75%) had com­ plete data after a minimum interval of one year. The mean ODI scores were 39.8 and improved to 24. The mean EQ­5D score was 0.40 and improved to 0.66. The mean VAS­leg im­ proved from 54 to 36. The mean VAS­back improved from 46 to 34. The mean MCS improved from 28 to 36, and, final­ ly, the mean PCS improved from 40 to 45. All p­values were 0.0000. CONCLUSION: Surgery improved all the patient­reported outcome measures and 82% of patients were satisfied. FUNDING: none. TRIAL REGISTRATION: This study was registered with the Danish Data Protection Agency. Lumbar spinal stenosis (LSS) is currently recognised as a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain. The syn­ drome is associated with diminished space available for the neural and vascular elements in the lumbar spine [1]. Symptoms often worsen during walking or pro­ longed standing [2]. LSS is typically seen in elderly pa­ tients. The exact prevalence remains unknown, but is es­ timated to be 9% in the general population and up to 47% in people over the age of 60 years [3]. According to the Danish National Spine Database (DaneSpine), 5,807 lumbar spine surgeries were performed in 2015 of which 42.2% were for LSS [4]. Even though DaneSpine does not reflect all spinal surgeries in Denmark, the distribution makes LSS reliable as the most common indication for spine surgery in Denmark. The number of surgical pro­ cedures is thought to be increasing due to a consider­ able growth of the elderly population. According to the Danish national guidelines, pa­ tients have to complete non­surgical treatment regi­ mens such as physiotherapy, medication or lifestyle modifications prior to surgery. Unfortunately, the evi­ dence supporting the effectiveness of non­surgical treat­ ments for LSS is inadequate. A Cochrane review pub­ lished in 2013 [5] about non­surgical treatments in patients with neurogenic claudication and LSS concluded that there was insufficient evidence to recommend any specific type of conservative treatment. The gold standard surgical treatment for LSS is decompression of the involved neural structures. De­ compression can be performed using different surgical techniques including various types of laminotomies and laminectomies. However, no clear evidence supports the superiority of either technique [6]. Ideally, the facets should be preserved, but they may ultimately be re­ sected to achieve an adequate decompression [7­9]. Fusion surgery can be added if segmental instability is discovered. Two recent systematic reviews evaluated surgical versus non­surgical treatments for LSS [10, 11]. How­ ever, clear evidence of either treatment option is lacking and high­quality randomised clinical trials are needed. No conclusion could be made as to whether surgical or nonsurgical treatment is preferable for individuals with LSS. However, current systematic reviews have diffi­ culties comparing the available RCTs due to insufficient description of the non­surgical treatment, large cross­ over rates and heterogeneity of reported outcomes. Despite the insufficient evidence from the systematic re­ views, additional studies showed both short and long­ term benefits from surgical treatment [12­14]. Patient are satisfied one year after decompression surgery for lumbar spinal stenosis Rune Tendal Paulsen1, Jamal Bech Bouknaitir2, Søren Fruensgaard3, Leah Carreron4 & Mikkel Andersen1