Only walking matters-assessment following lumbar stenosis decompression

Abstract

Purpose: Multiple outcome measures exist to evaluate the outcomes of spinal decompression surgery; however, these tend to be complex and are difficult to express to the patient pre-operatively to accurately guide their expectations. We present outcomes, in terms of walking distance measurement, of a prospective single surgeon series of 76 consecutive patients with spinal stenosis.

Methods: 76 patients (mean age 68.8 years; 48-91 years) had decompression surgery using spinous process osteotomy. Accurate measurement of walking distance was used as an outcome measure, and factors that affect it were evaluated. Walking distance was measured pre-operatively, post-operatively and at 3 months follow-up using a measuring wheel. The minimum follow-up was 5 years.

Results: The mean distances walked were 78.1, 419.9 and 1285 m, respectively. Pre-operative disc height (p = 0.023) and male gender (p = 0.039) predicted a significant improvement in walking distance, while age (p = 0.23), ASA grade (p = 0.39) and the number of levels operated on (p = 0.89) did not significantly affect the increase in walking distance. 12 patients experienced post-operative complications (15.8%), and at last clinical follow-up (6.3 years, 5.1-6.9 years) 27 patients (35.5%) had residual leg symptoms and 8 had undergone further revision procedures (10.5%).

Conclusion: This study demonstrates that walking distance is an accurate and accessible method of determining surgical outcomes.

Keywords: Measuring wheel; Self-paced walking test; Spinal stenosis decompression; Walking distance.