Pain and Functional Outcome After Microsurgical Decompression of Lumbar Spinal Stenosis: Very Short- and Long-Term Postoperative Analysis

Abstract

Study DesignMulticenter, prospective observational cohort study.Objectives109 patients with lumbar spine stenosis (LSS) undergoing minimally invasive decompression in 6 different centers (Germany, Italy, USA).MethodsThe demographic, surgical and clinical data was collected. Patients were examined preoperatively, immediately postoperatively, at 6 and 12 months after surgery with regard to pain (back and legs) and functional outcomes (ODI, SF-36, EQ5D).ResultsThe mean age of the cohort was 67 ± 11 years, with a BMI of 31.8 ± 6.6 kg/m². Most patients (93%) underwent single-level decompression, and postoperative adverse events occurred in 17% of cases. Significant initial reductions in back (6.0 ± 2.8 to 2.4 ± 2.1) and leg pain (6.4 ± 2.1 to 2.1 ± 2.5) were observed (P < 0.001). However, pain levels increased significantly by the 12-month period, reaching 3.9 ± 2.7 for back pain and 3.9 ± 2.4 for leg pain (P < 0.001). Functional scores (ODI) improved from 43 ± 18 at baseline to 36 ± 18 post-treatment but showed no further significant change (P = 0.509) by 12 months. Health status (EQ5D index) improved from 0.53 ± 0.33 to 0.82 ± 0.16 immediately post-treatment but declined to 0.75 ± 0.21 by 12 months (P = 0.011). SF36 physical scores also showed initial improvement but plateaued at follow-ups. Notably, high BMI and prior spine surgery were associated with worse outcomes.ConclusionAlthough minimally invasive decompression without fusion initially led to a significant improvement in patients with LSS, the results deteriorated significantly over the course of the observation period. Future studies should focus on strategies to ensure sustained improvement in symptoms in patients with lumbar stenosis undergoing decompression procedure.

Keywords: degenerative spine disease; functional outcome; lumbar spinal stenosis; microsurgical decompression; pp100016321; spine surgery.

Figure 1.

Outcome after decompression surgery of spinal stenosis for: (A) Back pain (NRS-BP), (B) leg pain (NRS-LP), (C) Oswestry Disability Index (ODI), (D) health status (EQ5D index value), (E) subjective health status (EQ5D-VAS), (F) the physical and G) mental health scale of the SF36 (SF36-PCS, SF36-MCS). Results are given as mean and its 95% confidence interval (CI) as error bars. P-values for significant differences are given in the figure.