Study design: A prospective observational 18-year follow-up study.
Objective: Aim of this study was to examine preoperative predictors for decreased pain in lumbar spinal stenosis (LSS) patients 18 years after surgery.
Summary of background data: LSS is the most common cause of low back surgery in patients over the age of 65 and a significant cause of low-back- and leg-pain. There are only a few studies with such a long follow-up period for LSS patients.
Methods: 102 patients with LSS underwent decompressive surgery at the baseline, and 35 of the original study sample took part in the 18-year follow-up study. The same questionnaire was filled by the study patients in the following time points: preoperative and 3 months, 1 year, 2 years, 5 years, 10 years and 18 years after surgery. VAS (Visual Analogic Scale) was used to evaluate overall pain at the aforementioned time points. Low back pain at rest and leg pain when walking were evaluated by the NRS-11 scale. Preoperative predictors in the models were non-smoking status, absence of previous lumbar surgery, better self-rated health and regular use of painkillers for symptom alleviation. Linear mixed models were used to evaluate changes in VAS-scores and preoperative predictors for VAS-scores over time.
Results: 18 years after surgery, patients reported statistically significant lower VAS-scores compared to baseline VAS-scores. 43% of the study patients who responded at the 18-year follow-up, underwent reoperation during the study period. Patients with reoperation experienced more low back pain at the 18-year follow-up. Statistically significant predictors for lower VAS-scores at 18 years after surgery were nonsmoking status, better self-rated health, absence of. previous surgery and regular use of painkillers less than 12 months.
Discussion & Conclusion: With these study results, factors influencing the surgical outcomes in LSS-patients can be assessed over a long, 18 years follow-up period.
Key words: Lumbar Spinal Stenosis, Visual Analogic Scale, surgical outcome, follow-up, non-smoking, use of painkillers, self-rated health