The impact of spinal surgery on the locomotive syndrome in patients with lumbar spinal stenosis in CDL stage 3: a retrospective study

Abstract

Objectives Locomotive syndrome (LS) is characterized by reduced mobility. Clinical decision limit (CDL) stage 3 in LS indicates physical frailty. Lumbar spinal canal stenosis (LSS) is one cause of LS, for which lumbar surgery is considered to improve the CDL stage. This study aimed to investigate the efficacy of lumbar surgery and independent factors for improving CDL stage in patients with LSS. Design A retrospective study Setting The study was conducted at the Department of Orthopaedic Surgery at University Hospital. Participants A total of 157 patients aged 65 and over with LSS underwent lumbar surgery. Interventions: The 25-Question Geriatric Locomotive Function scale (GLFS-25) was used to test for LS, and the timed up and go test (TUG) was used to evaluate functional ability. Lower limb pain was evaluated using a visual analog scale. Patients with at least one improvement in CDL stage following lumbarsurgery were included in the improvement group. Differences in lower-limb pain intensity between the groups were evaluated using the Wilcoxon rank-sum test. Spearman rank correlation coefficient was used to determine correlations between delta lower limb pain and delta GLFS-25. Logistic regression analysis was used to identify factors associated with improvement in LS. Results: The proportion of patients with improved CDL stage was 45.1% (improvement/non-improvement: 32/39). delta Lower limb pain was significantly reduced in the improvement group compared to that in the non-improvement group (51.0 [36.3-71.0] vs 40.0 [4.0-53.5]; p =0.0107). delta GLFS-25 significantly correlated with delta lower-limb pain (r =0.3774, p =0.0031). In a multiple logistic regression analysis, TUG and age were significantly associated with improvement in LS (odds ratio, 1.22; 95% confidence interval: 1.07-1.47). Conclusions: The lumbar surgery effectively improved the CDL stage in patients with LSS. In addition, TUG was an independent factor associated with improvement in the CDL.