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European Spine Journal
Published in: European Spine Journal 2/2017

01-02-2017 | Review Article

The clinical course of pain and disability following surgery for spinal stenosis: a systematic review and meta-analysis of cohort studies

Authors: Carolina G. Fritsch, Manuela L. Ferreira, Christopher G. Maher, Robert D. Herbert, Rafael Z. Pinto, Bart Koes, Paulo H. Ferreira

Published in: European Spine Journal | Issue 2/2017

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Abstract

Purpose

The aim of this study was to assess the clinical course of pain and disability in patients with lumbar spinal stenosis following surgery.

Methods

Electronic databases were searched to July 2014 and only prospective cohort studies assessing pain or disability following surgery for lumbar spinal stenosis were included. Two independent reviewers extracted data and assessed study quality. Estimates of pain and disability (expressed as 0–100 point scales) as well as 95 % confidence intervals were obtained using meta-regression. The effect of time was clearly non-linear, so it was modelled using fractional polynomial regression.

Results

From a total of 10,741 titles, 69 publications (64 cohort studies) were included in the review. Pooled estimate for pain pre-operatively was 63.4 (95 % CI 56.5; 70.3), reducing to 33.1 (95 % CI 24.2; 41.9) at 3 months and 19.2 points (95 % CI 9.2; 29.3) at 60 months. Pre-operative estimates of disability were 36.9 (95 % CI 32.6; 41.3), reducing to 16.3 (95 % CI 11.8; 20.9) at 3 months and 12.4 (95 % CI 7.7; 17.2) at 60 months.

Conclusion

Patients with lumbar spinal stenosis experience rapid symptom reduction after surgery, but should still expect to experience mild-to-moderate pain and disability 60 months later.
Appendix
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Literature
1.
2.
Comer CM, Redmond AC, Bird HA, Conaghan PG (2009) Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists. BMC Musculoskel Disord 10:121. doi:10.​1186/​1471-2474-10-121 CrossRef
3.
Winter CC, Brandes M, Muller C, Schubert T, Ringling M, Hillmann A, Rosenbaum D, Schulte TL (2010) Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study. BMC Musculoskelet Disord 11:233. doi:10.​1186/​1471-2474-11-233 CrossRefPubMedPubMedCentral
4.
Otani K, Kikuchi S, Yabuki S, Igarashi T, Nikaido T, Watanabe K, Konno S (2013) Lumbar spinal stenosis has a negative impact on quality of life compared with other comorbidities: an epidemiological cross-sectional study of 1862 community-dwelling individuals. Sci World J 2013:590652. doi:10.​1155/​2013/​590652 CrossRef
5.
Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2013) Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthr Cartil OARS 21(6):783–788. doi:10.​1016/​j.​joca.​2013.​02.​656 CrossRef
6.
7.
8.
Machado G, Ferreira P, Harris I, Pinheiro M, Koes B, van Tulder M, Rzewuska M, Maher C, Ferreira M (2015) Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One 10(3):e0122800CrossRefPubMedPubMedCentral
9.
Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B (1995) Lumbar spinal stenosis. Clinical and radiologic features. Spine (Phila Pa 1976) 20(10):1178–1186CrossRef
10.
11.
Gunzburg R, Keller TS, Szpalski M, Vandeputte K, Spratt KF (2003) A prospective study on CT scan outcomes after conservative decompression surgery for lumbar spinal stenosis. J Spinal Disord Tech 16(3):261–267CrossRefPubMed
12.
13.
Menezes CL, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO (2012) The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 184(11):E613–E624. doi:10.​1503/​cmaj.​111271 CrossRef
14.
Royston P, Sauerbrei W (2008) Multivariable model-building: a pragmatic approach to regression analysis based on fractional polynomials for modelling continuous variables. Wiley, ChichesterCrossRef
15.
Atlas S, Deyo R, Keller R, Chapin A, Patrick D, Long J, Singer D (1996) The maine lumbar spine study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica. Spine 21(15):1777–1786CrossRefPubMed
16.
Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE (2000) Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine 25(5):556–562CrossRefPubMed
17.
Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 30(8):936–943CrossRefPubMed
18.
Richter A, Schutz C, Hauck M, Halm H (2010) Does an interspinous device (Coflex) improve the outcome of decompressive surgery in lumbar spinal stenosis? One-year follow up of a prospective case control study of 60 patients. Eur Spine J 19(2):283–289CrossRefPubMed
19.
Richter A, Halm HF, Hauck M, Quante M (2014) Two-year follow-up after decompressive surgery with and without implantation of an interspinous device for lumbar spinal stenosis: a prospective controlled study. J Spinal Disord Tech 27(6):336–341CrossRefPubMed
20.
Schaeren S, Broger I, Jeanneret B (2008) Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine 33(18):E636–E642CrossRefPubMed
21.
Schnake KJ, Schaeren S, Jeanneret B (2006) Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine 31(4):442–449CrossRefPubMed
22.
Bednar DA (2002) Surgical management of lumbar degenerative spinal stenosis with spondylolisthesis via posterior reduction with minimal laminectomy. J Spinal Disord 15(2):105–109CrossRef
23.
24.
Forsth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, Ohagen P, Michaelsson K, Sanden B (2016) A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374(15):1413–1423. doi:10.​1056/​NEJMoa1513721 CrossRefPubMed
25.
Ammendolia C, Stuber KJ, Rok E, Rampersaud R, Kennedy CA, Pennick V, Steenstra IA, de Bruin LK, Furlan AD (2013) Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev 8:CD010712. doi:10.​1002/​14651858.​CD010712
26.
27.
Taylor VM, Deyo RA, Cherkin DC, Kreuter W (1994) Low back pain hospitalization. Recent US trends and regional variations. Spine (Phila Pa 1976) 19(11):1207–1212CrossRef
28.
Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI (2005) US trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 30(12):1441–1445CrossRef
29.
30.
Aalto TJ, Malmivaara A, Kovacs F, Herno A, Alen M, Salmi L, Kroger H, Andrade J, Jimenez R, Tapaninaho A, Turunen V, Savolainen S, Airaksinen O (2006) Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine 31(18):E648–E663. doi:10.​1097/​01.​brs.​0000231727.​88477.​da CrossRefPubMed
31.
32.
Knutsson B, Michaelsson K, Sanden B (2013) Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register. Spine 38(5):435–441CrossRefPubMed
33.
Aleem IS, Rampersaud YR (2014) Elderly patients have similar outcomes compared to younger patients after minimally invasive surgery for spinal stenosis. Clin Orthop 472:1824–1830CrossRefPubMed
34.
35.
Athiviraham A, Yen D (2007) Is spinal stenosis better treated surgically or nonsurgically? Clin Orthop 458:90–93PubMed
36.
Beyer F, Yagdiran A, Neu P, Kaulhausen T, Eysel P, Sobottke R (2013) Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life. Eur Spine J 22:2015–2021CrossRefPubMedPubMedCentral
37.
Bhadra AK, Raman AS, Tucker S, Noordeen HH (2008) Interspinous implant in lumbar spinal stenosis: a prospective cohort. Eur J Orthop Surg Tr 18:489–493CrossRef
38.
Castro-Menendez M, Bravo-Ricoy JA, Casal-Moro R, Hernandez-Blanco M, Jorge-Barreiro FJ (2009) Midterm outcome after microendoscopic decompressive laminotomy for lumbar spinal stenosis: 4-year prospective study. Neurosurgery 65:100–110CrossRefPubMed
39.
Cavagna R, Tournier C, Aunoble S, Bouler JM, Antonietti P, Ronai M et al (2008) Lumbar decompression and fusion in elderly osteoporotic patients: a prospective study using less rigid titanium rod fixation. J Spinal Disord Tech 21:86–91CrossRefPubMed
40.
Cavusoglu H, Turkmenogulu O, Kaya RA, Tuncer C, Colak I, Sahin Y et al (2007) Efficacy of unilateral laminectomy for bilateral decompression in lumbar spinal stenosis. Turk Neurosurg 17:100–108PubMed
41.
Chopko BW (2013) Long-term results of percutaneous lumbar decompression for LSS: two-year outcomes. Clin J Pain 29(11):939–943CrossRefPubMed
42.
Colak A, Topuz K, Kutlay M, Kaya S, Simsek H, Cetinkal A et al (2008) A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle. Eur Spine J 17:1745–1751CrossRefPubMedPubMedCentral
43.
Datta G, Gnanalingham KK, Peterson D, Mendoza N, O'Neill K, Van Dellen J et al (2004) Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction? Neurosurgery 54:1413–1420CrossRefPubMed
44.
Deer TR, Kim CK, Bowman RG, Ranson MT, Yee BS (2012) Study of percutaneous lumbar decompression and treatment algorithm for patients suffering from neurogenic claudication. Pain Physician 15:451–460PubMed
45.
Delank KS, Eysel P, Zollner J, Drees P, Nafe B, Rompe JD (2002) Undercutting decompression versus laminectomy. Clinical and radiological results of a prospective controlled trial. Orthopade 31:1048–1057CrossRefPubMed
46.
El-Abed K, Barakat M, Ainscow D (2011) Multilevel lumbar spinal stenosis decompression: midterm outcome using a modified hinge osteotomy technique. J Spinal Disord Tech 24:376–380CrossRefPubMed
47.
Endres S (2011) Instrumented posterolateral fusion - clinical and functional outcome in elderly patients. Ger Med Sci 9:Doc09
48.
Frazier DD, Lipson SJ, Fossel AH, Katz JN (1997) Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine 22:2025–2029CrossRefPubMed
49.
Fu YS, Zeng BF, Xu JG (2008) Long-term outcomes of two different decompressive techniques for lumbar spinal stenosis. Spine 33:514–518CrossRefPubMed
50.
Greiner-Perth R, Boehm H, Allam Y, El-Saghir H (2004) A less invasive approach technique for operative treatment of lumbar canal stenosis. Technique and preliminary results. Zentralbl Neurochir 65:185–190CrossRefPubMed
51.
Haro H, Maekawa S, Hamada Y (2008) Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis. Spine J 8:380–384CrossRefPubMed
52.
Herno A, Airaksinen O, Saari T (1993) Long-term results of surgical treatment of lumbar spinal stenosis. Spine 18:1471–1474CrossRefPubMed
53.
Ikuta K, Tono O, Oga M (2008) Clinical outcome of microendoscopic posterior decompression for spinal stenosis associated with degenerative spondylolisthesis–minimum 2-year outcome of 37 patients. Minim Invasive Neurosurg 51:267–271CrossRefPubMed
54.
Jakola AS, Sorlie A, Gulati S, Nygaard OP, Lydersen S, Solberg T (2010) Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study. BMC Surg 10:34CrossRefPubMedPubMedCentral
55.
Kaner T, Sasani M, Oktenoglu T, Cosar M, Ozer AF (2010) Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations. SAS Journal 4:92–97CrossRefPubMedPubMedCentral
56.
Kim HJ, Lee HM, Chun HJ, Kang KT, Kim HS, Park JO et al (2009) Restoration of bone turnover rate after decompression surgery in patients with symptomatic lumbar spinal stenosis: preliminary report. Spine 34:E635–E639CrossRefPubMed
57.
Kim HY, Choi BW (2013) Change of radiological parameters after interspinous implantation (X-stop®) in degenerative spinal stenosis. Eur J Orthop Surg Trauma 23:281–285CrossRef
58.
Komp M, Hahn P, Merk H, Godolias G, Ruetten S (2011) Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech 24:281–287CrossRefPubMed
59.
Kong DS, Kim ES, Eoh W (2007) One-year outcome evaluation after interspinous implantation for degenerative spinal stenosis with segmental instability. J Korean Med Sci 22:330–335CrossRefPubMedPubMedCentral
60.
Kuchta J, Sobottke R, Eysel P, Simons P (2009) Two-year results of interspinous spacer (X-Stop) implantation in 175 patients with neurologic intermittent claudication due to lumbar spinal stenosis. Eur Spine J 18:823–829CrossRefPubMedPubMedCentral
61.
Mannion RJ, Guilfoyle MR, Efendy J, Nowitzke AM, Laing RJ, Wood MJ (2012) Minimally invasive lumbar decompression: long-term outcome, morbidity, and the learning curve from the first 50 cases. J Spinal Disord Tech 25:47–51CrossRefPubMed
62.
Mekhail N, Costandi S, Abraham B, Samuel SW (2012) Functional and patient-reported outcomes in symptomatic lumbar spinal stenosis following percutaneous decompression. Pain Pract 12:417–425CrossRefPubMed
63.
Mekhail N, Vallejo R, Coleman MH, Benyamin RM (2012) Long-term results of percutaneous lumbar decompression mild for spinal stenosis. Pain Pract 12:184–193CrossRefPubMed
64.
Ng LC, Tafazal S, Sell P (2007) The effect of duration of symptoms on standard outcome measures in the surgical treatment of spinal stenosis. Eur Spine J 16:199–206CrossRefPubMed
65.
Ohtori S, Yamashita M, Yamauchi K, Inoue G, Koshi T, Suzuki M et al (2010) Change in Modic type 1 and 2 signals after posterolateral fusion surgery. Spine 35:1231–1235CrossRefPubMed
66.
Paker N, Turkmen C, Bugdayci D, Tekdos D, Erbil M (2005) Comparison of conservative and surgical treatment results in lumbar spinal stenosis. Turk Neurosurg 15:182–184
67.
68.
Panagiotis ZE, Athanasios K, Panagiotis D, Minos T, Charis M, Elias L (2006) Functional outcome of surgical treatment for multilevel lumbar spinal stenosis. Acta Orthop 77:670–676CrossRefPubMed
69.
Pao JL, Chen WC, Chen PQ (2009) Clinical outcomes of microendoscopic decompressive laminotomy for degenerative lumbar spinal stenosis. Eur Spine J 18:672–678CrossRefPubMedPubMedCentral
70.
Papavero L, Thiel M, Fritzsche E, Kunze C, Westphal M, Kothe R (2009) Lumbar spinal stenosis: prognostic factors for bilateral microsurgical decompression using a unilateral approach. Neurosurgery 65:182–187PubMed
71.
Parker SL, Fulchiero EC, Davis BJ, Adogwa O, Aaronson OS, Cheng JS et al (2011) Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy. Spine J 11:705–711CrossRefPubMed
72.
Parlato C, Iavarone A, Gentile M, Albanese R, Moraci A (2013) Outcome of lumbar intervertebral foraminal stenosis surgery and depression. Eur Neurol 69:304–308CrossRefPubMed
73.
Postacchini R, Ferrari E, Cinotti G, Menchetti PPM, Postacchini F (2011) Aperius interspinous implant versus open surgical decompression in lumbar spinal stenosis. Spine J 11:933–939CrossRefPubMed
74.
Reyes-Sanchez A, Sanchez-Bringas G, Zarate-Kalfopulos B, Alpizar-Aguirre A, Lara-Padilla E, Rosales-Olivares LM (2013) [Transpedicular dynamics stabilization in the treatment of lumbar stenosis. Fourth years follow-up]. Cir Cir 81:48–54PubMed
75.
Schulte TL, Schubert T, Winter C, Brandes M, Hackenberg L, Wassmann H et al (2010) Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery. Eur Spine J 19:1855–1864CrossRefPubMedPubMedCentral
76.
Shabat S, Arinzon Z, Folman Y, Leitner J, David R, Pevzner E et al (2008) Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians. Eur Spine J 17:193–198CrossRefPubMed
77.
Shabat S, Miller LE, Block JE, Gepstein R (2011) Minimally invasive treatment of lumbar spinal stenosis with a novel interspinous spacer. Clin Interv Aging 6:227–233PubMedPubMedCentral
78.
79.
Sinikallio S, Lehto SM, Aalto T, Airaksinen O, Kroger H, Viinamaki H (2010) Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: a two-year perspective. BMC Musculoskel Dis 11:152CrossRef
80.
Sobottke R, Aghayev E, Roder C, Eysel P, Delank SK, Zweig T (2012) Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry. Eur Spine J 21:411–417CrossRefPubMed
81.
Stromqvist BH, Berg S, Gerdhem P, Johnsson R, Moller A, Sahlstrand T et al (2013) X-stop versus decompressive surgery for lumbar neurogenic intermittent claudication: randomized controlled trial with 2-year follow-up. Spine 38:1436–1442CrossRefPubMed
82.
Surace MF, Fagetti A, Fozzato S, Cherubino P (2012) Lumbar spinal stenosis treatment with Aperius perclid interspinous system. Eur Spine J 21(1):S69–S74CrossRefPubMed
83.
Tenhula J, Lenke LG, Bridwell KH, Gupta P, Riew D (2000) Prospective functional evaluation of the surgical treatment of neurogenic claudication in patients with lumbar spinal stenosis. J Spinal Disord 13:276–282CrossRefPubMed
84.
Westergaard L, Hauerberg J, Springborg JB (2009) Outcome after surgical treatment for lumbar spinal stenosis: the lumbar extension test is not a predictive factor. Spine 34:E930–E935CrossRefPubMed
85.
Wilkinson JS, Fourney DR (2012) Failure of percutaneous remodeling of the ligamentum flavum and lamina for neurogenic claudication. Neurosurgery 71:86–91CrossRefPubMed
86.
Willen J, Wessberg PJ, Danielsson B (2008) Surgical results in hidden lumbar spinal stenosis detected by axial loaded computed tomography and magnetic resonance imaging: an outcome study. Spine 33:E109–E115CrossRefPubMed
87.
Wong Chung-Ting M, Chan Pak-Ho A, Cheung KK (2012) A prospective study on the outcome of degenerative lumbar spinal stenosis treated with open laminotomy. J Orthop Trauma Rehab 16:62–65
88.
Wong WHM (2012) Mild interlaminar decompression for the treatment of lumbar spinal stenosis: procedure description and case series with 1-year follow-up. Clin J Pain 28:534–538CrossRefPubMed
89.
Yamashita K, Ohzono K, Hiroshima K (2006) Five-year outcomes of surgical treatment for degenerative lumbar spinal stenosis: a prospective observational study of symptom severity at standard intervals after surgery. Spine 31:1484–1490CrossRefPubMed
90.
Yasar B, Simsek S, Er U, Yigitkanli K, Eksioglu E, Altug T et al (2009) Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal: clinical article. J Neurosurg Spine 11:347–352CrossRefPubMed
91.
Yucesoy K, Ozer E (2002) Inverse laminoplasty for the treatment of lumbar spinal stenosis. Spine 27:E316–E320
92.
Yukawa Y, Lenke LG, Tenhula J, Bridwell KH, Riew KD, Blanke K (2002) A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. J Bone Joint Surg 84-A:1954–1959
93.
Mlyavykh S, Ludwig SC, Mobasser JP, Kepler CK, Anderson G (2013) Twelve-month results of a clinical pilot study utilizing pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis. J Neurosurg Spine 18(4):347–355. doi:10.​3171/​2012.​11.​SPINE12402 CrossRefPubMed
Metadata
Title
The clinical course of pain and disability following surgery for spinal stenosis: a systematic review and meta-analysis of cohort studies
Authors
Carolina G. Fritsch
Manuela L. Ferreira
Christopher G. Maher
Robert D. Herbert
Rafael Z. Pinto
Bart Koes
Paulo H. Ferreira
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 2/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4668-0

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