Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome

Abstract

Study Design: Prospective register cohort study. Objectives: The indication for surgery in patients with lumbar spinal stenosis (LSS) is considered to be leg pain and neurogenic claudication (NC). Nevertheless, a significant part of patients operated for LSS have mild leg pain levels defined as leg pain ≤minimally important clinical difference (MICD). Information is lacking on how to inform these patients about the probable outcome of surgery. The objective was to report the outcome of surgery for LSS in patients with a mild preoperative level of leg pain. Methods: A total of 2559 patients operated upon for LSS with preoperative leg pain ≤3 NRS (Numerical Rating Scale) were evaluated for outcome at the 1-year follow-up. NRS for back pain, the Oswestry Disability Index (ODI), and the EuroQol (EQ-5D) were used. Results: In the period 2007 to 2017, we identified 3239 patients (14%) who had mild leg pain (≤3 on the NRS). In this cohort, leg pain increased 0.40 (0.56-0.37) and back pain decreased 1.0 (0.95-1.2) at the 1-year follow up. ODI decreased 11.1 (10.2-11.4) and the EQ-5D increased 0.15 (0.17-0.14). A total of 31% reached successful outcome in terms of back pain, 43% in terms of ODI and 48% in terms of EQ-5D. 63% of the patients were satisfied with the outcome. Conclusion: A minority of patients with mild leg pain levels operated upon for LSS attain MICD for back pain, ODI, and EQ-5D. The results from this study can aid the surgeon in the shared decision-making process before surgery.

Lumbar spinal stenosis

“…A cohort study published in 2020 (2559 patients) reported unsatisfactory outcomes with surgery for LSS in patients with mild leg pain (3 on a 10 point scale) 29. A Cochrane review (five randomised controlled trials, 643 patients) in 2016 reported no clear benefits with surgery compared with non-surgical treatment.…”

Global Trends and Hotspots of Minimally Invasive Surgery in Lumbar Spinal Stenosis: A Bibliometric Analysis

“… 8 Furthermore, the number of surgical procedures performed annually for LSS is on the rise, particularly for minimally invasive surgical approaches. 9 , 10 This trend can be attributed to the increased functional expectations and longer life expectancy of LSS patients.…”