Decompression Surgery Improves Back Pain in Lumbar Stenosis

How Decompression Surgery Improves the Lower Back Pain in Patient with Lumbar Degenerative Stenosis

A Propensity-Score-Matched Analysis

Mitsuru Yagi, MD, PhD; Satoshi Suzuki, MD, PhD; Satoshi Nori, MD, PhD; Yohei Takahashi, MD, PhD; Osahiko Tsuji, MD, PhD; Narihito Nagoshi, MD, PhD; Masaya Nakamura, MD, PhD; Morio Matsumoto, MD, PhD; Kota Watanabe, MD, PhD

Disclosures

Spine. 2022;47(7):557-564.

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],

Table 1. Demographic Data and Improvement of Low Back Pain and HRQOLs Among Surgically Treated Patient With LSS
Variables	Total
No. of patients	436
Age (yrs)	71.6 ± 8.4 [49–92]
Sex (female/male)	137 (31.4%)/299 (68.6%)
Etiology
LSS	399 (91.5%)
DS (Meyerding grade I)	37 (8.5%)
Frailty
Robust	153 (35.1%)
Prefrail	200 (45.9%)
Frail	83 (19.0%)
Current smoker	11 (2.5%)
Job type
Housewife	112 (25.7%)
Office job	173 (40.0%)
Labor job	49 (11.2%)
Unemployed	102 (23.4%)
No. of comorbidities
0	112 (25.7%)
1	189 (43.3%)
2	103 (23.6%)
≥ 3	32 (7.3%)
Baseline HRQOL (JOABPEQ)
Lumbar function	53.5 ± 31.1
Lower back pain	42.2 ± 36.1
Social life function	38.7 ± 21.5
Mental health	44.7 ± 18.5
Walking ability	29.9 ± 27.9
Lower back pain (VAS score)
Baseline	5.61 ± 2.82 [0–10]
2-yr after surgery	3.31 ± 2.84 [0–9]
Level decompressed	1.75 ± 0.83 [1–4]
Time of surgery (min)	74.0 ± 39.4 [24.0–205.0]
Estimated blood loss (mL)	45.1 ± 125.2 [5.0–600.0]
Perioperative complication	30 (6.9%)
Recovery of HRQOLs (2-yr postop—baseline)
VAS score
Lower back pain	−2.31 ± 3.23 [−2.61, −2.00]
Leg pain	−3.24 ± 3.51 [−3.58, −2.90]
Leg numbness	−2.92 ± 5.56 [−3.46, −2.37]
JOABPEQ
Lumbar function	16.24 ± 30.65 [13.33, 19.15]
Lower back pain	28.77 ± 39.10 [25.06, 32.49]
Social life function	24.77 ± 27.79 [22.12, 27.41]
Mental health	11.75 ± 19.64 [9.88, 13.63]
Walking ability	33.16 ± 35.65 [29.78, 36.54]

DS indicates degenerative spondylolisthesis; LSS, lumbar spinal stenosis. Means and standard deviations. Percentage in parenthesis. Range in bracket. 95% CI in bracket in recovery of HRQOLs. All HRQOLs improved statistically significant (P < 0.001, respectively).

Table 2. Logistic Regression Analysis of the Risk of 2-year Postoperative Residual Lower Back Pain (VAS Score ≥4.5) Among Surgically Treated Patient With LSS
Variables	Odds Ratio	P Value
Sex (female)	1.905 [1.219, 2.976]	0.005*
Age (every 10 yr)	1.262 [0.975, 1.634]	0.077
Joint replacement	1.331 [0.934, 1.897]	0.113
Frailty (mFI-5 class)	1.561 [0.523, 4.659]	0.424
Baseline JOABPEQ: Mental health (<40)	1.179 [0.737, 1.886]	0.492
Physical dependence (JOABPEQ3–1 = 1)	1.018 [0.586, 1.767]	0.951
Baseline lower back pain (VAS ≥7.5)	1.943 [1.226, 3.079]	0.005*
Constant	0.094	<0.001*

95% CI in bracket.
*Indicates statistically significant.

Table 3. Logistic Regression Analysis of the Risk of Baseline Severe Low Back Pain (VAS Score ≥7.5) Among Surgically Treated Patient With LSS
Variables	Odds Ratio	P Value
Sex (female)	1.696 [1.064, 2.705]	0.027*
Age (every 10 yr)	1.038 [0.797, 1.353]	0.782
Cerebral palsy	2.816 [0.730, 10.859]	0.133
Frailty (mFI-5 class)	1.086 [0.750, 1.573]	0.827
Joint replacement	1.667 [0.529, 5.255]	0.383
Baseline JOABPEQ: Mental health (<40)	3.785 [2.399, 5.973]	<0.001*
Functional status	1.033 [0.581, 1.834]	0.912
Constant	0.167	<0.001*