The Clinical Status of Patients With Lumbar Spinal Stenosis Reflects Their Individual Decision to Undergo or Defer Lumbar Spinal Surgery.

Abstract

To evaluate whether functional, clinical, and self-reported tests reflect lumbar spinal stenosis patients' decisions to undergo or defer surgery. Among 108 participants, 77 chose surgery (SG), and 31 opted to wait and see (WaSG) whether they got better spontaneously. Both groups were assessed at baseline (t 0 ) and 3 months (t 1 ), with additional self-reported measures at 6 (t 2 ) and 12 months (t 3 ). Key outcomes included corridor walk distance, chair sit-to-stand repetitions, grip strength, and various pain and disability indices. At baseline, SG reported higher leg pain (NPRS-leg: Δ = 1.66, P = 0.002) and poorer functional outcomes across multiple tests. By t 1 , both groups improved in disability, but SG showed greater reductions in the Oswestry Disability Index (Δ = 7.85, P = 0.001) and sustained improvements in leg pain at subsequent assessments. WaSG consistently engaged in more walking (mean Δ = 123.5 minutes, P < 0.001). Regression analyses indicated that surgery status, flexibility, and strength significantly predicted improvements in disability (adjusted R² = 0.296). Logistic regression identified predictors for surgery choice, including biological sex, leg pain intensity, walking performance, and weekly walking hours. Functional status, self-reported disability, and fear-avoidance beliefs in lumbar spinal stenosis patients reflect their subjective decision regarding surgery and highlight the importance of baseline leg pain, calf strength, walking-related parameters, and physical function in recovery. Observational prospective cohort.