Improving effect of microendoscopic decompression surgery on low back pain in patients with lumbar spinal stenosis and predictive factors of postoperative residual low back pain: a single-center retrospective study

Abstract

Background Although there are reports on the effectiveness of microendoscopic laminotomy using a spinal endoscope as decompression surgery for lumbar spinal stenosis, predicting the improvement of low back pain (LBP) still poses a challenge, and no clear index has been established. This study aimed to investigate whether microendoscopic laminotomy for lumbar spinal stenosis improves low back pain and determine the preoperative predictors of residual LBP. Methods In this single-center retrospective study, we examined 202 consecutive patients who underwent microendoscopic laminotomy for lumbar spinal stenosis with a preoperative visual analog scale (VAS) score for LBP of ≥40 mm. The lumbar spine Japanese Orthopaedic Association (JOA), and VAS scores for LBP, leg pain (LP), and leg numbness (LN) were examined before and at 1 year after surgery. Patients with a 1-year postoperative LBP-VAS of ≥25 mm composed the residual LBP group. The preoperative predictive factors associated with postoperative residual LBP were analyzed. Results JOA scores improved from 14.1 preoperatively to 20.2 postoperatively (p < 0.001), LBP-VAS improved from 66.7 to 29.7 mm (p < 0.001), LP-VAS improved from 63.8 to 31.2 mm (p < 0.001), and LN-VAS improved from 63.3 to 34.2 mm (p < 0.001). Ninety-eight patients (48.5%) had a postoperative LBP-VAS of ≥25 mm. Multiple logistic regression analysis revealed that Modic type 1 change (odds ratio [OR], 5.61; 95% confidence interval [CI], 1.68–18.68; p = 0.005), preoperative VAS for LBP ≥ 70 mm (OR, 2.19; 95% CI, 1.17–4.08; p = 0.014), and female sex (OR, 1.98; 95% CI, 1.09–3.89; p = 0.047) were preoperative predictors of residual LBP. Conclusion Microendoscopic decompression surgery had an ameliorating effect on LBP in lumbar spinal stenosis. Modic type 1 change, preoperative VAS for LBP, and female sex were predictors of postoperative residual LBP, which may be a useful index for surgical procedure selection.

Risk Factors in the Prediction of Leg Numbness after Spinal Endoscopic Surgery: Evaluation and Development of a Nomogram

“…Preoperatively, LBP-VAS is considered a predictor of leg numbness after spinal endoscopic surgery. Taiji et al showed the leg numbness VAS to be as high as 61.4 to 65.2 in patients with lower back pain after endoscopic spinal surgery [ 11 ]. A multiple logistic regression study also showed preoperative lower back pain to be a risk factor (OR = 2.19) for postoperative lower back pain [ 11 ].…”

“…Taiji et al showed the leg numbness VAS to be as high as 61.4 to 65.2 in patients with lower back pain after endoscopic spinal surgery [ 11 ]. A multiple logistic regression study also showed preoperative lower back pain to be a risk factor (OR = 2.19) for postoperative lower back pain [ 11 ]. A herniated disc destroys the annulus fibrosus, releasing chemicals that irritate the sinus nerve and cause lower back pain [ 26 ].…”

“…Our study used LN-VAS, which is a visual pain analog scale (0-100 mm horizontal analog scale) commonly used for leg numbness. Several reports in the literature have also evaluated the efficacy of LN-VAS after spinal endoscopic surgery [ 7 , 9 , 11 ].…”

“…Finally, we collected the patients' clinical scores, including preoperative and postoperative JOA, preoperative and postoperative LBP-VAS, preoperative and postoperative leg pain VAS (LP-VAS), and preoperative and postoperative LN-VAS. Previously reported literature was used to refer to the criteria for grading clinical data, which included the degree of LSS, degree of endplate disease, LBP-VAS, LP-VAS, and LN-VAS[11][12][13].2.2. StatisticalAnalysis.…”

Posterolateral Fusion Surgery with Decompression: An Effective Treatment Option for Lumbar Spinal Stenosis

“…Lumbar spinal stenosis (LSS) is a condition in which the dural tract and the nerve roots are compressed due to the degeneration of the intervertebral disk, and facet joints. This leads to the thickening/buckling of ligamentum flavum (1). The first clinical description was attributed to Verbiest in 1954.…”