Deterioration in clinical outcomes in patients with lumbar spinal stenosis 12 -years following surgery.

Abstract

Spinal lumbar spine stenosis is the most common indication for spinal surgery. A few prospective studies report longer-term outcomes for this population, especially considering radiographic parameters. This study aimed to examine the longer-term patient-rated outcomes (PROs) and radiographic measures in surgically treated lumbar spinal stenosis patients, compare those who underwent revision surgery to those who did not, and identify factors correlated with requiring revision surgery. Prospective study of consecutive patients treated for lumbar spinal stenosis. 211 patients surgically treated for spinal stenosis in a prospective observational cohort with more than 10 years of follow-up OUTCOME MEASURES: Patient-rated outcomes (PROs) evaluated leg pain, back pain, disability, and general health. Radiographic measurements include pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis. PROs were prospectively collected preoperatively and at 3 months, 1 year, 2 years, and 3 years postoperatively. In the present study an attempt was made to follow-up with patients on a longer-term. PROs were compared to normative values, and longitudinal regression models for repeated measures were used to compare PROs between patients who had revision and those who did not. Out of 211 patients, 50/192 (26%) had at least 1 revision surgery. 98 patients completed PROs and radiographic assessments with a median follow-up time of 12 years (range 9 -15 years). By 12 years, the results demonstrated that these patients, on average, had a significant loss of general and spine-specific function initially achieved through surgery while maintaining a relative improvement in pain compared to baseline scores. Compared to normative values, these 98 patients had worse back pain, leg pain, and disability 12 years after surgery (p<0.001). Patients who had revision had worse SF-36 mental functioning (SF-36 MCS) before surgery (p=0.025). Patients who had undergone revision had worse disability, physical function, and pain compared to those who did not have revision surgery. At 12 years, patients who underwent revision surgery had clinically worse lumbar lordosis (12 years: 47° vs. 41°, p= 0.010) and pelvic incidence-lumbar lordosis mismatch (10° vs. 16°, p= 0.048). Surgery initially improved this patient cohort PROs but yielded lasting benefits only for pain scores, not for function, at the 12-year follow-up period. Compared to the normative population, this cohort exhibited a lower quality of life in the long-term after surgery. Patients who had revision surgery reported worse physical functioning and pain compared to patients who did not require revision surgery.