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OBJECTIVE: The authors' objective was to investigate whether sagittal balance improves in patients with spinal stenosis after decompression alone. METHODS: This prospective longitudinal cohort study compared preoperative and 6-month postoperative 36-inch full-length radiographs in patients aged older than 60 years. Patients underwent decompression alone for central lumbar spinal stenosis with either a minimally invasive bilateral laminotomy for central decompression, unilateral laminectomy as an over-the-top procedure for bilateral decompression, or traditional wide laminectomy with removal of the spinous processes on both sides. The following radiographic parameters were measured: sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), PI-LL mismatch, coronal Cobb angle, and sacral slope (SS). Patient-reported outcome measures (PROMs) were collected, including scores on the Oswestry Disability Index (ODI), visual analog scale (VAS) for leg and back pain, and EQ-5D. RESULTS: Forty-five patients (24 males) with a mean ± SD age of 71.8 ± 5.6 years were included. Sagittal balance showed statistically significant improvement, with the mean SVA decreasing from 52.3 mm preoperatively to 33.9 mm postoperatively (p = 0.0001). The authors found an increase in LL, from mean -41.5° preoperatively to -43.9° postoperatively, but this was not statistically significant (p = 0.055). A statistically significant decrease in PI-LL mismatch from mean 8.4° preoperatively to 5.8° postoperatively was found (p = 0.002). All PROM scores showed significant improvement after spinal decompression surgery. The correlations between SVA and all PROMs were statistically significant at both preoperative and postoperative time points, although most correlations were weak except for those between preoperative SVA and ODI (r = 0.55) and between SVA and VAS for leg pain (r = 0.58). CONCLUSIONS: Sagittal balance and PROMs show improvement at short-term follow-up evaluations in patients who have undergone decompression alone for lumbar spinal stenosis.
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STUDY DESIGN: Validation study. OBJECTIVES: To translate and validate the Zurich Claudication Questionnaire (ZCQ) into a Danish version of the disease-specific patient-reported outcome measure (PROM) for patients with lumbar spinal stenosis (LSS), which assesses symptom severity, physical function, and satisfaction after surgery. METHOD: Translation into a Danish version of the original questionnaire by back- and forward-translating the questionnaire and finally transforming a prefinal test version into a final and cross-cultural adapted version. Validation was performed as a cohort study assessing floor-ceiling effects, internal consistency, test-retest reproducibility, criterion validity, discriminant validity, and responsiveness to change. RESULTS: Fifty-three patients were consecutively included in the study, 53 healthy controls were matched. Floor effect was seen in the postoperative data. Internal consistency, Cronbach's alpha was good to excellent. Substantial test-retest reproducibility was found using Cohen's weighted kappa. The Danish ZCQ showed moderate to strong association with similar domains of Oswestry Disability Index, Short Form 36, Euro QoL 5D, visual analogue scale-leg and back. The questionnaire showed significant responsiveness to change and a significant discriminant validity between LSS patients and healthy controls. CONCLUSION: This study shows the Danish translation of the original ZCQ to be well understood by Danish patients. The Danish version is furthermore a reliable and valid questionnaire, which is responsive to change.
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STUDY DESIGN: Propensity-matched retrospective study of patients prospectively enrolled in Danespine. OBJECTIVE: The aim of this study was to report 5-year patient reported outcome in lumbar spinal stenosis (LSS) patients who underwent wide laminectomy (WL), segmental bilateral laminotomies (SBL), or unilateral hemilaminectomy (UHL) with bilateral decompression. SUMMARY OF BACKGROUND DATA: The optimal procedure for LSS remains controversial. Studies have shown no difference in short term outcomes among micro-laminectomy, hemi-laminotomies, broad laminectomy, and laminectomy with instrumented fusion. METHODS: Patients with spinal stenosis who were enrolled in DaneSpine at two spine centers from January 2010 until May 2014 and underwent WL0, SBL, or UHL with bilateral decompression were identified. Patients completed standard questionnaires preoperatively and 1, 2, and 5 years after surgery. Patients in the three cohorts were propensity-matched using age, sex, body mass index (BMI), smoking status, number of surgical levels, American Society of Anesthesiologists (ASA) score, and patient-reported outcome measures (PROMs). RESULTS: Propensity matching produced 62 cases in each group. There were no differences in PROM among the three cohorts at five years follow up. Twelve patients were re-operated at the index level. The most frequent indication of reoperation was repeat decompression after SBL. Regression analysis revealed no statistical significant associations between the incidence of reoperation and age, sex, number of operated levels, ASA score, BMI, center, smoking status, or having a dural tear at index operation. CONCLUSION: This study revealed no significant difference PROMs, reoperation rates or time to reoperation at five years follow up between SBLs, UHL, or WL in patients operated for central LSS.Level of Evidence: 4.
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Laminectomía , Estenosis Espinal , Descompresión Quirúrgica , Humanos , Laminectomía/efectos adversos , Vértebras Lumbares/cirugía , Medición de Resultados Informados por el Paciente , Estudios Retrospectivos , Estenosis Espinal/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Surgical treatment for lumbar spinal stenosis is associated with both short- and long-term benefits with improvements in patient function and pain. Even though most patients are satisfied postoperatively, some studies report that up to one-third of patients are dissatisfied. OBJECTIVE: To present clinical outcome data and identify prognostic factors related to patient satisfaction 1 yr after posterior decompression surgery for lumbar spinal stenosis. METHODS: This multicenter register study included 2562 patients. Patients were treated with various types of posterior decompression. Patients with previous spine surgery or concomitant fusion were excluded. Patient satisfaction was analyzed for associations with age, sex, body mass index, smoking status, duration of pain, number of decompressed vertebral levels, comorbidities, and patient-reported outcome measures, which were used to quantify the effect of the surgical intervention. RESULTS: At 1-yr follow-up, 62.4% of patients were satisfied but 15.1% reported dissatisfaction. The satisfied patients showed significantly greater improvement in all outcome measures compared to the dissatisfied patients. The outcome scores for the dissatisfied patients were relatively unchanged or worse compared to baseline. Association was seen between dissatisfaction, duration of leg pain, smoking status, and patient comorbidities. Patients with good walking capacity at baseline were less prone to be dissatisfied compared to patients with poor walking capacity. CONCLUSION: This study found smoking, long duration of leg pain, and cancerous and neurological disease to be associated with patient dissatisfaction, whereas good walking capacity at baseline was positively associated with satisfaction after 1 yr.
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Descompresión Quirúrgica , Satisfacción del Paciente/estadística & datos numéricos , Estenosis Espinal , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/estadística & datos numéricos , Humanos , Medición de Resultados Informados por el Paciente , Pronóstico , Estenosis Espinal/diagnóstico , Estenosis Espinal/epidemiología , Estenosis Espinal/cirugíaRESUMEN
INTRODUCTION: Lumbar spinal stenosis (LSS) is a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain. The syndrome is associated with diminished space available for the neural and vascular elements in the lumbar spine. LSS is typically seen in elderly patients, its prevalence is estimated to be 47% in people over the age 60 years. LSS is the most common reason for spine surgery in Denmark and the number of surgical procedures is likely to increase due to demographic changes. The purpose of this study was to evaluate the patient-reported outcomes and perioperative complications of spinal decompression surgery in LSS patients. METHODS: This study is a retrospective study based on prospectively collected data from 3,420 consecutive patients with clinical and magnetic resonance imaging confirmed LSS. Patients were treated with posterior decompression surgery without fusion. Data were obtained from the DaneSpine register and collected pre- and post-operatively after a minimum interval of one year. The outcome measures were Oswestry Disability Index (ODI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS), 36-Short Form Mental Component Summary (MCS), 36-Short Form Physical Component Summary (PCS) and self-reported walking distance. RESULTS: Of 3,420 cases enrolled, 2,591 (75%) had complete data after a minimum interval of one year. The mean ODI scores were 39.8 and improved to 24. The mean EQ-5D score was 0.40 and improved to 0.66. The mean VAS-leg improved from 54 to 36. The mean VAS-back improved from 46 to 34. The mean MCS improved from 28 to 36, and, finally, the mean PCS improved from 40 to 45. All p-values were 0.0000. CONCLUSION: Surgery improved all the patient-reported outcome measures and 82% of patients were satisfied. FUNDING: none. TRIAL REGISTRATION: This study was registered with the Danish Data Protection Agency.