Impact of spinal surgery on locomotive syndrome in patients with lumbar spinal stenosis in clinical decision limit stage 3: a retrospective study

Ichiro Nakae; Ryuki Hashida; Ryota Otsubo; Sohei Iwanaga; Hiroo Matsuse; Kimiaki Yokosuka; Tatsuhiro Yoshida; Takuma Fudo; Shinji Morito; Takahiro Shimazaki; Kei Yamada; Kimiaki Sato; Naoto Shiba; Koji Hiraoka

doi:10.1186/s12891-023-06966-x

Impact of spinal surgery on locomotive syndrome in patients with lumbar spinal stenosis in clinical decision limit stage 3: a retrospective study

BMC Musculoskelet Disord. 2023 Oct 28;24(1):851. doi: 10.1186/s12891-023-06966-x.

Authors

Ichiro Nakae¹, Ryuki Hashida^{2

3}, Ryota Otsubo⁴, Sohei Iwanaga^{1

4}, Hiroo Matsuse^{1

4}, Kimiaki Yokosuka¹, Tatsuhiro Yoshida¹, Takuma Fudo¹, Shinji Morito¹, Takahiro Shimazaki¹, Kei Yamada¹, Kimiaki Sato¹, Naoto Shiba^{1

4}, Koji Hiraoka¹

Affiliations

¹ Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.
² Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan. hashida_ryuuki@med.kurume-u.ac.jp.
³ Division of Rehabilitation, Kurume University Hospital, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan. hashida_ryuuki@med.kurume-u.ac.jp.
⁴ Division of Rehabilitation, Kurume University Hospital, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.

Abstract

Background: Locomotive syndrome (LS) is characterized by reduced mobility. Clinical decision limit (CDL) stage 3 in LS indicates physical frailty. Lumbar spinal canal stenosis (LSS) is one of the causes of LS, for which lumbar surgery is considered to improve the CDL stage. This study aimed to investigate the efficacy of lumbar surgery and independent factors for improving the CDL stage in patients with LSS.

Methods: This retrospective study was conducted at the Department of Orthopaedic Surgery at our University Hospital. A total of 157 patients aged ≥ 65 years with LSS underwent lumbar surgery. The 25-Question Geriatric Locomotive Function scale (GLFS-25) was used to test for LS, and the Timed Up and Go test (TUG) was used to evaluate functional ability. Lower limb pain was evaluated using a visual analog scale. Patients with at least one improvement in the CDL stage following lumbar surgery were included in the improvement group. Differences in lower limb pain intensity between the groups were evaluated using the Wilcoxon rank-sum test. The Spearman's rank correlation coefficient was used to determine correlations between Δ lower limb pain and Δ GLFS-25. Logistic regression analysis was used to identify factors associated with improvement in LS.

Results: The proportion of patients with improved CDL stage was 45.1% (improvement/non-improvement: 32/39). Δ Lower limb pain was significantly reduced in the improvement group compared with that in the non-improvement group (51.0 [36.3-71.0] vs 40.0 [4.0-53.5]; p = 0.0107). Δ GLFS-25 was significantly correlated with Δ lower limb pain (r = 0.3774, p = 0.0031). Multiple logistic regression analysis revealed that TUG and age were significantly associated with improvement in LS (odds ratio, 1.22; 95% confidence interval: 1.07-1.47).

Conclusions: Lumbar surgery effectively improved the CDL stage in patients with LSS. In addition, TUG was an independent factor associated with improvement in the CDL.

Keywords: Locomotive syndrome; Low back pain; Lumbar spinal canal stenosis; Visual analog scale.

MeSH terms

Aged
Humans
Lumbar Vertebrae / surgery
Pain
Postural Balance
Retrospective Studies
Spinal Stenosis* / complications
Spinal Stenosis* / surgery
Time and Motion Studies