Identifying biopsychosocial factors that impact decompressive laminectomy outcomes in veterans with lumbar spinal stenosis: a prospective cohort study

Abstract

One in 3 patients with lumbar spinal stenosis undergoing decompressive laminectomy (DL) to alleviate neurogenic claudication do not experience substantial improvement. This prospective cohort study conducted in 193 Veterans aimed to identify key spinal and extraspinal factors that may contribute to a favorable DL outcome. Biopsychosocial factors evaluated pre-DL and 1 year post-DL were hip osteoarthritis, imaging-rated severity of spinal stenosis, scoliosis/kyphosis, leg length discrepancy, comorbidity, fibromyalgia, depression, anxiety, pain coping, social support, pain self-efficacy, sleep, opioid and nonopioid pain medications, smoking, and other substance use. The Brigham Spinal Stenosis (BSS) questionnaire was the main outcome. Brigham Spinal Stenosis scales (symptom severity, physical function [PF], and satisfaction [SAT]) were dichotomized as SAT < 2.42, symptom severity improvement ≥ 0.46, and PF improvement ≥ 0.42, and analyzed using logistic regression. Sixty-two percent improved in 2 of 3 BSS scales (ie, success). Baseline characteristics associated with an increased odds of success were—worse BSS PF (odds ratio [OR] 1.24 [1.08-1.42]), greater self-efficacy for PF (OR 1.30 [1.08-1.58]), lower self-efficacy for pain management (OR 0.80 [0.68-0.94]), less apparent leg length discrepancy (OR 0.71 [0.56-0.91]), greater self-reported alcohol problems (OR 1.53 [1.07-2.18]), greater treatment credibility (OR 1.31 [1.07-1.59]), and moderate or severe magnetic resonance imaging-identified central canal stenosis (OR 3.52 [1.06-11.6]) moderate, OR 5.76 [1.83-18.1] severe). Using opioids was associated with lower odds of significant functional improvement (OR 0.46 [0.23-0.93]). All P < 0.05. Key modifiable factors associated with DL success—self-efficacy, apparent leg length inequality, and opioids—require further investigation and evaluation of the impact of their treatment on DL outcomes.

Prevalence of multimorbid degenerative lumbar spinal stenosis with knee or hip osteoarthritis: a systematic review and meta-analysis

“…Absolute agreement between reviewers was 90% with a Kappa of 0.62. After full-text screening, ten articles met the eligibility criteria for this review [ 37 – 46 ]. Two excluded articles provided prevalence data on LSS with comorbid knee and hip OA, but were excluded because separate estimates for knee and hip OA were not provided [ 47 , 48 ].…”

“…Six studies estimating the prevalence of index LSS with comorbid hip OA were included [ 37 , 39 , 41 , 44 – 46 ] (Table 2 ). Studies were performed in Korea ( n=2 ) [ 39 , 41 ], USA ( n =2) [ 45 , 46 ], Japan [ 44 ], and Switzerland [ 37 ].…”

“…Six studies estimating the prevalence of index LSS with comorbid hip OA were included [ 37 , 39 , 41 , 44 – 46 ] (Table 2 ). Studies were performed in Korea ( n=2 ) [ 39 , 41 ], USA ( n =2) [ 45 , 46 ], Japan [ 44 ], and Switzerland [ 37 ]. Study designs were primarily cohort ( n =4) [ 37 , 39 , 44 , 46 ] with one cross-sectional study [ 41 ] and one randomized controlled trial [ 45 ].…”

“…Studies were performed in Korea ( n=2 ) [ 39 , 41 ], USA ( n =2) [ 45 , 46 ], Japan [ 44 ], and Switzerland [ 37 ]. Study designs were primarily cohort ( n =4) [ 37 , 39 , 44 , 46 ] with one cross-sectional study [ 41 ] and one randomized controlled trial [ 45 ]. All included studies enrolled LSS patients from secondary care settings, except one which included LSS patients from mixed settings [ 45 ].…”

“…The single study ( n =193) using a combined case definition of LSS with a combined definition of hip OA was 35% (95% CI 29-42%) [ 46 ]. The pooled prevalence in two studies ( n =860) using combined definitions of LSS and clinical definitions of hip OA was 17% (95% CI 14-19%) [ 37 , 45 ].…”