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

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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.

作者简介

Aleksandr Krutko

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: ortho-ped@mail.ru
ORCID iD: 0000-0002-2570-3066
SPIN 代码: 8006-6351

MD, Dr Sci. (Med.)

俄罗斯联邦, Moscow

Anton Nazarenko

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: anazarenko@mail.ru
ORCID iD: 0000-0003-1314-2887
SPIN 代码: 1402-5186

MD, Dr Sci. (Med.), professor of Russian Academy of Sciences

俄罗斯联邦, Moscow

Gleb Balychev

Priorov National Medical Research Center of Traumatology and Orthopedics

编辑信件的主要联系方式.
Email: balichev.gleb@gmail.com
ORCID iD: 0000-0001-7884-6258
SPIN 代码: 9647-8748
俄罗斯联邦, Moscow

Evgenii Baykov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: Evgen-bajk@mail.ru
ORCID iD: 0000-0002-4430-700X
SPIN 代码: 5367-5438

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Olga Leonova

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: onleonova@gmail.com
ORCID iD: 0000-0002-9916-3947
SPIN 代码: 4907-0634

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

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2. Fig. 1. Patient B., 83 years old. VAS in back — 5 points; VAS in leg — 8 points. ODI=47.5%. DN-4 — 2 points. MRI of the lumbar spine — degenerative stenosis L4-L5 Schizas grade D, degenerative spondylolisthesis L4 grade I. (Fig. 1, a, b). Postural radiography of the spine — Barrey Index = 1.76 (Fig. 1, c). Surgical treatment — microsurgical “over-the-top” decompression at L4-L5. Lumbar spine MRI after 1 year — recalibration of the spinal canal to Schizas grade A4 (Fig. 1, d, e). ODI — 4.0%, VAS in leg — 0 points, VAS in back — 3 points. Regression according to ODI by 43.50%, recalibration of the spinal canal confirmed, satisfaction with surgical treatment on the Likert scale: 5 — “Much better than before the surgery”. Treatment success achieved.

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3. Fig. 2. Patient I., 62 years old: VAS in back — 4 points, VAS in legs — 5 points, ODI=64.44%, DN4 before surgery — 7 points; a, b — MRI lumbar spine — degenerative stenosis L3-L4, Schizas grade C (Fig. 2, a, b); Postural radiography of the spine — Barrey Index =0.71 (Fig. 2, c). Surgical treatment — microsurgical “over-the-top” decompression at L3-L4. Despite the achieved recalibration to Schizas grade B, the patient continues to have pain in the lower extremities. ODI — 48.89%, VAS in legs — 4 points, VAS in back — 3 points. Clinical success achieved — ODI regression by 15.5% recalibration of the spinal canal, but the patient is not satisfied with the result of surgical treatment — 3 on the Likert scale (“state without change”). The high value of neuropathic pain remains: DN4=7 points. Surgical treatment defined unsuccessful.

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