Association between preoperative activity level and functional outcome at 12 months following surgical decompression for lumbar spinal stenosis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>This study defines the association of preoperative physical activity level with functional outcomes at 3 and 12 months following surgical decompression for lumbar spinal stenosis.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Data were collected as a prospective observational registry at a single institution from 2012 through 2015, and then analyzed with a retrospective cohort design. Patients who were able to participate in activities outside the home preoperatively were compared to patients who did not participate in such activities, with respect to 3-month and 12-month functional outcomes postintervention, adjusted for relevant confounders.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Ninety-nine patients were included. At baseline, sedentary/inactive patients (n = 55) reported greater back pain, lower quality of life, and higher disability than similarly treated patients who were active preoperatively. Both cohorts experienced significant improvement from baseline in back pain, leg pain, disability, and quality of life at both 3 and 12 months after lumbar decompression surgery. At 3 months postintervention, sedentary/inactive patients reported more leg pain and worse disability than patients who performed activities outside the home preoperatively. However, at 12 months postintervention, there were no statistically significant differences between the two cohorts in back pain, leg pain, quality of life, or disability. Multivariate analysis revealed that sedentary/inactive patients had improved disability and higher quality of life after surgery compared to baseline. Active patients experienced greater overall improvement in disability compared to inactive patients.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Sedentary/inactive patients have a more protracted recovery after lumbar decompression surgery for spinal stenosis, but at 12 months postintervention can expect to reach similar long-term outcomes as patients who are active/perform activities outside the home preoperatively.</jats:p></jats:sec>

Assessing the Impact of Neurogenic Claudication on Outcomes Following Decompression With Lumbar Interbody Fusions in Patients With Lumbar Spinal Stenosis

“…16 A separate study focusing on elective lumbar spinal surgeries found that patients with private insurance have slightly greater improvement in their postoperative quality of life compared to patients with public insurance, though both groups experienced significant functional improvement overall postoperatively. 17 Similarly, we noted a significant difference in the prevalence of certain surgically relevant comorbidities between patients with and without NC. In particular, patients with NC were more likely to also have chronic blood loss anemia, depression, diabetes mellitus with complications, hypertension, obesity, peripheral vascular disease, and renal failure.…”

“…16 A separate study focusing on elective lumbar spinal surgeries found that patients with private insurance have slightly greater improvement in their postoperative quality of life compared to patients with public insurance, though both groups experienced significant functional improvement overall postoperatively. 17…”

What Preoperative Factors Are Associated With Achieving a Clinically Meaningful Improvement and Satisfaction After Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis?

“…27 Another key finding of the present study was that patients with less disability and lower BMI were more likely to experience a clinically meaningful improvement in back pain and quality of life. Supporting these findings, another study by Elsayed et al 28 of 99 patients undergoing lumbar spine surgery found that patients with poorer preoperative function and activity reported greater back pain, lower quality of life, and higher disability postoperatively. In a study of 529 patients who underwent surgery for lumbar spinal stenosis, Hebert et al 29 found that those with greater preoperative disability were more likely to have poor overall outcomes after surgery as well.…”

“…This in turn may have value with respect to patient selection, preoperative counselling, and managing patient expectations when considering lumbar spine surgery. 28 Existing literature has shown that psychiatric conditions, such as anxiety and depression, significantly influence postoperative expectation fulfillment and patient satisfaction after spine surgery. 34,35 In a study of 919 patients undergoing lumbar decompression or fusion surgery, Miller et al 36 found that preoperative depression was significantly associated with reduced improvement in postoperative quality of life, as measured by the EuroQol five-dimensions (EQ-5D) outcome measure.…”

“…This in turn may have value with respect to patient selection, preoperative counselling, and managing patient expectations when considering lumbar spine surgery. 28 …”