Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Introduction: The management of elective surgeries during the COVID-19 pandemic was controversial. Movement restrictions varied depending on the pandemic phase, with significant differences in public perception of the virus and social life, especially between the early and late phases. However, it remains unclear how outcomes for LSS surgery were affected during the pandemic and whether there were differences in surgical outcomes between the early and late phases. This study aimed to retrospectively analyze older adults who underwent surgery for LSS during the COVID-19 pandemic and to explore the characteristics of cases from both the early and late phases.

Methods: Medical records of patients aged 65 and older who underwent LSS surgery between April 2020 and April 2023 were reviewed. The Zurich Claudication Questionnaire and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were administered preoperatively and at 6 months and 1 year postoperatively.

Results: Figure 1 illustrates the trend in newly confirmed COVID-19 cases during the pandemic in Japan¹. The period from April 2020 to September 2021 was classified as the early phase, while October 2021 to April 2023 was classified as the late phase (Figure 1). The early phase includes the relatively mild first through fifth waves of COVID-19 infections, while the late phase encompasses the more severe sixth through eighth waves (Figure 1). This study evaluated a total of 267 older patients with LSS, with 138 undergoing surgeries during the early phase and 129 during the late phase. There was one case of COVID-19 infection during hospitalization in the early phase and none in the late phase. Significant differences were found between the early and late phases in the distribution of American Society of Anesthesiologists physical status (ASA) and frequency of degenerative lumbar scoliosis (DLS). When the association between the COVID-19 pandemic phase and effective case of surgery treatment on JOABPEQ was examined, the multivariable adjusted relative risks of effective case in social life domain for the late-stage group were 0.7 (95% CI = 0.5–0.9) at both 6 months and 1 year postoperatively using the early-phase group as the reference. No significant differences were found in the other four domains at either 6 months or 1 year postoperatively.

Conclusions: Our study revealed that older patients with LSS in the late phase had significantly worse ASA scores and a higher frequency of DLS. Furthermore, these patients experienced poorer overall surgical outcomes, especially in the social life domain. This may be due not only to the worse preoperative ASA scores and increased frequency of DLS in the late phase but also to changes in social life that occurred during the different phases of the pandemic.

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