Success predictors of decompressive surgical treatment for lumbar degenerative spinal canal stenosis

Abstract

BACKGROUND: Decompressive surgical treatment for degenerative lumbar stenosis significantly improves patient clinical status. However, in some cases, patients are not satisfied with the outcomes. Various studies have examined clinical and morphological factors to improve the results of surgical interventions.

AIM: To identify clinical and morphological predictors of the success of decompressive surgical interventions for lumbar degenerative stenosis.

MATERIALS AND METHODS: This retrospective study included 61 patients who underwent surgery for mono- and postsegmental lumbar degenerative stenosis. Clinical and demographic data and the stage of degenerative changes in the functional spinal unit and sagittal balance of the spine were assessed. The success of surgical treatment was defined as simultaneous compliance with three criteria after 6–18 months: achievement of MCID for ODI (≥12%), recalibration of the spinal canal at the level of intervention according to MRI data (Schizas regression to ≥1 stage), and improvement of the patient’s subjective feeling (4–5 on the Likert scale). Logistic regression analysis was used to identify predictors of treatment outcome.

RESULTS: A significant decrease in the intensity of pain syndrome (VAS in back and leg) and an improvement in the quality of life (ODI) after surgery (p <0.001) were found in all patients. In 73.8% of cases, the MCID threshold exceeded for ODI, whereas in 75.41%, patients were satisfied with surgical treatment. The success rate of surgical intervention was 65.57%. In one-factor regression analysis of clinical, demographic, and morphological parameters, the only independent predictor of surgical treatment was neuropathic pain before surgery according to the DN4 questionnaire (OR=1.52; p=0.011).

CONCLUSION: Decompressive surgical treatment for degenerative lumbar stenosis is an effective treatment method, regardless of the extent and degree of degenerative changes in the spinal–motor segments and concomitant degenerative pathology, including disruption of sagittal balance. The predicting factor of the success of decompressive intervention is the severity of preoperative neuropathic pain.

Keywords

degenerative stenosis / lumbar spine / decompressive surgery / neuropathic pain syndrome

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