Abstract and Introduction
Abstract
Study Design: Multicenter retrospective case series of patients treated surgically for lumbar spinal stenosis (LSS)
Objective: We investigated how laminectomy improves lower back pain (LBP) and the factors associated with poor improvement.
Summary of Background Data: Lumbar laminectomy is effective for alleviating neurological symptoms caused by LSS, whereas its effect on LBP is still controversial.
Methods: A retrospective review of prospectively collected data from 436 patients (age 72 yrs, 69% males) who underwent laminectomy for LSS with 2 years of follow-up. We analyzed the following risk factors for residual LBP by uni- and multivariate analyses: age, sex, smoking, occupation, comorbidities, frailty, joint replacement, vertebral fracture, DISH, HRQOL, complications, and the presence of spinal instability. The LBP of male and female patients was analyzed after propensity score matching of known confounders. Patient-reported outcomes (JOABPEQ and VAS scores) were obtained at baseline and the 2-year postoperative follow-up.
Results: LBP was significantly improved at 2 years post operation (VAS change 2.3 [95% CI 2.0–2.6], P < 0.01). Fifty-five percent of the patients achieved an MCID, with 67% having no or mild LBP. In the multivariate analysis, sex and baseline LBP were independent risk factors (female: OR 1.9 [1.2–3.0], baseline LBP [VAS≥7.5]: OR 1.9 [1.2–3.1]). Furthermore, the independent risk factors for severe baseline LBP were sex and mental status (female: OR 1.7 [1.1–2.7], P = 0.03, mental status: OR 3.8 [2.4–6.0], P < 0.01). However, an analysis of 102 pairs of propensity-score-matched male and female patients showed no difference in the improvement of LBP (male vs. female: VAS 3.8 ± 2.8 vs. 4.0 ± 2.9, P = 0.61, VAS change 3.1 ± 2.9 vs. 2.7 ± 3.0, P = 0.38).
Conclusion: Decompression surgery for LSS significantly improved LBP. Sex and baseline LBP were risk factors for residual LBP. However, when males and females were matched by confounders, no difference was found in the LBP after surgery. Patients with severe baseline LBP may need further evaluation for their mental status because these patients are likely to have mental problems that potentially contribute to persistent LBP.
Level of Evidence: 4
Introduction
Lumbar spinal stenosis (LSS) is a common degenerative disease that often benefits from surgical treatment when there is persistent neurogenic claudication.[1–8] It is widely accepted that lumbar laminectomy is effective for the treatment of neurological symptoms caused by LSS.[1–6] Several recent randomized controlled trials have shown that surgical treatment is more effective than conservative treatment for LSS in certain patients. Nevertheless, the degree to which laminectomy improves lower back pain (LBP) is still controversial.
LBP is a common nonspecific symptom in middle-aged to elderly adults with various spinal disorders, including LSS, lumbar disc herniation, spinal metastasis, spondylitis, etc.[2,4] Iizuka et al. reported that the prevalence of chronic low back pain was 25% in the general Japanese population, and among subjects with chronic low back pain, 62% had nonspecific low back pain.[9] Kalichman et al.[10] analyzed the prevalence of LSS in their community-based study and described that the prevalence of acquired stenosis increased with age and that LSS was associated with a 3-fold increased risk of experiencing LBP. LBP can even occur as part of the pathology of systemic diseases, such as collagen diseases, fatigue and mental diseases and conditions, such as depression and psychological distress.[9–15]
The reported prevalence of substantial LBP before surgery ranges from 10% to 30% in patients with lumbar degenerative diseases.[11,12] Although several factors, including age, occupation, symptom duration, mental status, smoking history, spinal instability, and sex, have been reported as risk factors for postoperative persistent LBP, not all LSS patients with substantial baseline LBP have residual postoperative LBP.[16–19] Moreover, the existing literature has mainly focused on the recovery of neurological symptoms after decompression surgery, but when preoperative LBP improved and risk factors for persistent LBP are not well understood. Herein, we sought to elucidate the effect of lumbar laminectomy on the improvement of LBP and the factors associated with persistent LBP in decompression surgery for LSS.
Spine. 2022;47(7):557-564. © 2022 Lippincott Williams & Wilkins
