Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

Abstract

Leg pain/numbness and gait disturbance, two major symptoms in the lower extremities of lumbar spinal stenosis (LSS), are generally expected to be alleviated by decompression surgery. However, the paucity of information available to patients before surgery about specific predictors has resulted in some of them being dissatisfied with the surgical outcome when the major symptoms remain after the procedure. This prospective, observational study sought to identify the predictors of the outcome of a decompression surgery: modified fenestration with restorative spinoplasty. Of 109 consecutive LSS patients who underwent the decompression surgery, 89 (56 males and 33 females) completed the 2 year follow-up. Both leg pain/numbness and gait disturbance determined by the Japanese Orthopedic Association scoring system were significantly improved at 2 years after surgery compared to those preoperative, regardless of potential predictors including gender, preoperative presence of resting numbness in the leg, drop foot, cauda equina syndrome, degenerative spinal deformity or myelographic filling defect, or the number of decompressed levels. However, 27 (30.3%) and 13 (14.6%) patients showed residual leg pain/numbness and gait disturbance, respectively. Among the variables examined, the preoperative resting numbness was associated with residual leg pain/ numbness and gait disturbance, and the preoperative drop foot was associated with residual gait disturbance, which was confirmed by logistic regression analysis after adjustment for age and gender. This is the first study to identify specific predictors for these two remaining major symptoms of LSS after decompression surgery, and consideration could be given to including this in the informed consent.

Prevalence, characteristics, and burden of failed back surgery syndrome: the influence of various residual symptoms on patient satisfaction and quality of life as assessed by a nationwide Internet survey in Japan

“…Voorhies et al found significant differences between measurements of success or satisfaction collected by a surgeon vs. those collected by another patient, even for relatively simple lumbar surgery 32. One report from Japan indicated that only 27 of 89 patients (30.3%) showed residual leg pain/numbness 2 years after surgery for lumbar spinal stenosis 33. However, our data indicate that low back pain and leg numbness disappeared in only 25% and 34% of patients, respectively.…”

Prognostic factors in lumbar spinal stenosis surgery

“…However, one third of patients are not satisfied with the outcome because of residual leg and back pain, inferior function, and poor health-related quality of life (Katz et al 1995, Airaksinen et al 1997, Jönsson et al 1997, Jansson et al 2009, Strömqvist et al 2009, Hara et al 2010). …”

Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network

“…Drop foot was defined as a tibialis anterior muscle strength score less than 3 (of 5) [1,2,6,8]. Tibialis anterior muscle strength was graded as 3-when patients could dorsiflex and invert their ankles while they were seated but could not achieve full ROM.…”