The Implication of Preoperative Central Stenosis on Patient-Reported Outcomes After Lumbar Decompression Surgery

Caleb M Yeung; Jeremy C Heard; Yunsoo Lee; Mark J Lambrechts; Sydney Somers; Akash Singh; Evan Bloom; Nicholas D D'Antonio; Delano Trenchfield; Anthony Labarbiera; John J Mangan; Jose A Canseco; Barrett I Woods; Mark F Kurd; Ian D Kaye; Joseph K Lee; Alan S Hilibrand; Alexander R Vaccaro; Christopher K Kepler; Gregory D Schroeder

doi:10.1016/j.wneu.2023.06.038

The Implication of Preoperative Central Stenosis on Patient-Reported Outcomes After Lumbar Decompression Surgery

World Neurosurg. 2023 Jun 19:S1878-8750(23)00806-9. doi: 10.1016/j.wneu.2023.06.038. Online ahead of print.

Authors

Caleb M Yeung¹, Jeremy C Heard¹, Yunsoo Lee², Mark J Lambrechts³, Sydney Somers⁴, Akash Singh⁴, Evan Bloom⁴, Nicholas D D'Antonio¹, Delano Trenchfield¹, Anthony Labarbiera⁴, John J Mangan¹, Jose A Canseco¹, Barrett I Woods¹, Mark F Kurd¹, Ian D Kaye¹, Joseph K Lee¹, Alan S Hilibrand¹, Alexander R Vaccaro¹, Christopher K Kepler¹, Gregory D Schroeder¹

Affiliations

¹ Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
² Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: Yunsoo.Lee@rothmanortho.com.
³ Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri, USA.
⁴ Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

PMID: 37343674
DOI: 10.1016/j.wneu.2023.06.038

Abstract

Objective: To assess the impact of central stenosis severity on patient-reported outcomes after lumbar decompression.

Methods: Patient diagnosis, demographics, and surgical characteristics were collected via query search and manual chart review of electronic medical records. The inclusion criteria were posterior lumbar decompressions from 2014-2020, with accessible magnetic resonance imaging reports. As previously validated by Lee et al., central stenosis was determined on magnetic resonance imaging and graded as none, mild, moderate, or severe. Patients were dichotomized into 2 groups to improve statistical power for comparisons: none or mild central stenosis and moderate or severe central stenosis. Patient-reported outcome measures (PROMs) were compared between cohorts at 1 year postoperatively. Statistical significance was set at P < 0.05.

Results: On bivariate analysis, no significant differences were noted between cohorts with regard to preoperative, 1-year postoperative, and delta PROMs. In addition, no significant difference in the number of patients attaining minimal clinically important difference (MCID) for each PROM was noted between cohorts. With the exception of mental score of the Short Form-12 survey, all intragroup preoperative to postoperative PROMs indicated significant improvement (all P < 0.05) after lumbar decompression surgery. Multivariate regression identified moderate or severe central canal stenosis as a significant independent predictor of improvement in visual analog scale back (estimate = -1.464, P = 0.045).

Conclusions: We demonstrate that patients with moderate or severe central spinal stenosis may have more improvement in back pain than those with mild or no central stenosis after lumbar spine decompression surgery.

Keywords: Central stenosis; Lumbar decompression; Patient-reported outcomes.