Relief of Low Back Pain After Posterior Decompression for Lumbar Spinal Stenosis

Abstract

Study Design. A retrospective study.Objective. The aim of this study was to confirm that decompression for lumbar spinal stenosis (LSS) relieves low back pain (LBP) as adequately as it relieves leg pain and to identify predictors for inadequate LBP relief. Summary of Background Data. Although decompression for LSS is generally thought to yield worse results for LBP than for leg pain, some studies have reported similar improvements in pain scores between LBP and leg pain. To treat LBP or take measures to prevent inadequate LBP relief, reliable predictors for LBP relief should be identified. Methods. We retrospectively reviewed 175 patients who underwent posterior element-preserving decompression and evaluated the relief of LBP and leg pain using numeric rating scales (NRSs). Associations between demographic, clinical, or imaging parameters and LBP relief at 1 and 4 years were analyzed by stepwise linear regression analyses. The imaging parameters included Modic change type 1, disc degeneration, foraminal stenosis, vertebral slipping (within Grade 1), scoliosis (<158) and lordosis. Results. The mean improvements in LBP and leg pain NRS scores from baseline were 5.22 and 4.70 points (P ¼ 0.064, paired t test) at 1 year and 5.12 and 4.62 points (P ¼ 0.068) at 4 years, respectively. Poor LBP scores at 4 years were significantly associated with long-lasting LBP (beta ¼ 0.31, P < 0.0001) and moderate or severe arm symptoms with cervical spinal cord compression or intramedullary hyperintense signal on T2weighted MRI (beta ¼ 0.22, P ¼ 0.0014). The imaging parameters of the lumbar spine failed to show clear associations with poor LBP scores at 4 years, although Modic change type 1 showed a significant association with poor LBP scores at 1 year (beta ¼ 0.28, P < 0.0001). Conclusion.Posterior decompression relieves LBP as well as leg pain. Long-lasting LBP and concurrent symptomatic cervical myelopathy are important predictors for inadequate LBP relief. There were no reliable imaging parameters predictive of inadequate LBP relief. K e y w o r d s : a r m s y m p t o m , c e r v i c a l m y e l o p a t h y , decompression, disc degeneration, duration of LBP, foraminal stenosis, leg pain, low back pain, lumbar spinal stenosis, Modic change Type 1, numeric rating scale, predictor, spinous process-splitting approach, suspension laminoplasty.

Efficacy and safety of interspinous process device compared with alone decompression for lumbar spinal stenosis: A systematic review and meta-analysis

“…Hence, the posterior decompression surgery was suggested for patients with leg predominant symptoms. [ 44 , 45 ] Our meta-analysis demonstrated that the leg pain had no significant difference between IPD treatment and alone decompression surgery at different time-points of follow-up (6, 12 mo and the last follow-up). We considered that patients in both groups received traditional decompression surgery, which effectively alleviated leg pain by nerve root decompression.…”

Clinical analysis of low back pain in patients with lumbar degenerative disc disease with Modic I/II changes after percutaneous transforaminal endoscopic discectomy: a retrospective study

“…Although our commonly used posterior lumbar decompression surgery can adequately relieve leg symptoms, patients with low back pain often fail to achieve the desired results. 4 The concept of Modic change (MC), reported by Modic in 1988, has been accepted and discussed in the medical community, but its connection to low back pain remains obscure and worth exploring. 5 At present, MC is generally divided into three different types: type I MC (MCI) represents in ammatory edema of the bone marrow, type II (MCII)represents steatosis from red to yellow bone marrow, and type III (MCIII) changes represent the endplate hardening.…”

Intervertebral vacuum phenomenon – prevalence and severity CT-scan analysis in patients older than 50 years: a retrospective cohort study

“…Among degenerative changes in the spine, degenerative disc disease (5), facet joint osteoarthritis (6), and lumbar spinal stenosis are the most common anatomical findings (7). As the discs continue their degenerative process, some patients develop intervertebral vacuum phenomenon (IVP), a relatively common finding, especially with advanced degeneration (8).…”