How Decompression Surgery Improves the Lower Back Pain in Patient with Lumbar Degenerative Stenosis

A Propensity-Score-Matched Analysis

Mitsuru Yagi, MD, PhD; Satoshi Suzuki, MD, PhD; Satoshi Nori, MD, PhD; Yohei Takahashi, MD, PhD; Osahiko Tsuji, MD, PhD; Narihito Nagoshi, MD, PhD; Masaya Nakamura, MD, PhD; Morio Matsumoto, MD, PhD; Kota Watanabe, MD, PhD

Disclosures

Spine. 2022;47(7):557-564.

Conclusion

In the present study, we clearly described that decompression surgery for LSS significantly improved LBP. Among the patients analyzed, female patients and patients who had baseline severe LBP were likely to have persistent LBP. However, when male and female patients were propensity score matched for background, LBP improved similarly after surgery. Although LBP in patients with LSS improved with decompression surgery, patients with severe baseline pain may need further evaluation for their mental status at least before surgery because these patients are likely to have psychological problems that potentially contribute to persistent LBP.

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No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Acknowledgment
We gratefully acknowledge Dr. Takehiro Michikawa for his advice for statistical analyses

Table 1. Demographic Data and Improvement of Low Back Pain and HRQOLs Among Surgically Treated Patient With LSS
Variables	Total
No. of patients	436
Age (yrs)	71.6 ± 8.4 [49–92]
Sex (female/male)	137 (31.4%)/299 (68.6%)
Etiology
LSS	399 (91.5%)
DS (Meyerding grade I)	37 (8.5%)
Frailty
Robust	153 (35.1%)
Prefrail	200 (45.9%)
Frail	83 (19.0%)
Current smoker	11 (2.5%)
Job type
Housewife	112 (25.7%)
Office job	173 (40.0%)
Labor job	49 (11.2%)
Unemployed	102 (23.4%)
No. of comorbidities
0	112 (25.7%)
1	189 (43.3%)
2	103 (23.6%)
≥ 3	32 (7.3%)
Baseline HRQOL (JOABPEQ)
Lumbar function	53.5 ± 31.1
Lower back pain	42.2 ± 36.1
Social life function	38.7 ± 21.5
Mental health	44.7 ± 18.5
Walking ability	29.9 ± 27.9
Lower back pain (VAS score)
Baseline	5.61 ± 2.82 [0–10]
2-yr after surgery	3.31 ± 2.84 [0–9]
Level decompressed	1.75 ± 0.83 [1–4]
Time of surgery (min)	74.0 ± 39.4 [24.0–205.0]
Estimated blood loss (mL)	45.1 ± 125.2 [5.0–600.0]
Perioperative complication	30 (6.9%)
Recovery of HRQOLs (2-yr postop—baseline)
VAS score
Lower back pain	−2.31 ± 3.23 [−2.61, −2.00]
Leg pain	−3.24 ± 3.51 [−3.58, −2.90]
Leg numbness	−2.92 ± 5.56 [−3.46, −2.37]
JOABPEQ
Lumbar function	16.24 ± 30.65 [13.33, 19.15]
Lower back pain	28.77 ± 39.10 [25.06, 32.49]
Social life function	24.77 ± 27.79 [22.12, 27.41]
Mental health	11.75 ± 19.64 [9.88, 13.63]
Walking ability	33.16 ± 35.65 [29.78, 36.54]

DS indicates degenerative spondylolisthesis; LSS, lumbar spinal stenosis. Means and standard deviations. Percentage in parenthesis. Range in bracket. 95% CI in bracket in recovery of HRQOLs. All HRQOLs improved statistically significant (P < 0.001, respectively).

Table 2. Logistic Regression Analysis of the Risk of 2-year Postoperative Residual Lower Back Pain (VAS Score ≥4.5) Among Surgically Treated Patient With LSS
Variables	Odds Ratio	P Value
Sex (female)	1.905 [1.219, 2.976]	0.005*
Age (every 10 yr)	1.262 [0.975, 1.634]	0.077
Joint replacement	1.331 [0.934, 1.897]	0.113
Frailty (mFI-5 class)	1.561 [0.523, 4.659]	0.424
Baseline JOABPEQ: Mental health (<40)	1.179 [0.737, 1.886]	0.492
Physical dependence (JOABPEQ3–1 = 1)	1.018 [0.586, 1.767]	0.951
Baseline lower back pain (VAS ≥7.5)	1.943 [1.226, 3.079]	0.005*
Constant	0.094	<0.001*

95% CI in bracket.
*Indicates statistically significant.

Table 3. Logistic Regression Analysis of the Risk of Baseline Severe Low Back Pain (VAS Score ≥7.5) Among Surgically Treated Patient With LSS
Variables	Odds Ratio	P Value
Sex (female)	1.696 [1.064, 2.705]	0.027*
Age (every 10 yr)	1.038 [0.797, 1.353]	0.782
Cerebral palsy	2.816 [0.730, 10.859]	0.133
Frailty (mFI-5 class)	1.086 [0.750, 1.573]	0.827
Joint replacement	1.667 [0.529, 5.255]	0.383
Baseline JOABPEQ: Mental health (<40)	3.785 [2.399, 5.973]	<0.001*
Functional status	1.033 [0.581, 1.834]	0.912
Constant	0.167	<0.001*