Abstract
BACKGROUND CONTEXT
Lumbar spinal canal stenosis caused by degenerative lumbar spondylolisthesis is one
of the most common indications for spinal surgery. However, the factors that influence
its long-term (>10 years) outcomes remain unknown.
DESIGN
This is a post-hoc analysis of a prospective randomized study.
PURPOSE
This study aimed to determine factors that influence the long-term outcomes of instrumentation
surgery for lumbar spinal canal stenosis due to degenerative lumbar spondylolisthesis.
PATIENT SAMPLE
Patients aged ≤75 years with single L4/5 level lumbar canal stenosis caused by degenerative
lumbar spondylolisthesis prospectively underwent instrumentation surgery at two hospitals
between May 1, 2003, and April 30, 2012; the final follow-up examination was on May
20, 2021.
OUTCOME MEASURES
The following data were collected: modified Japanese Orthopedic Association (JOA)
score, JOA score recovery rate, visual analog scale (VAS) score for lower back and
leg pain, and scores from eight short-form 36 (SF-36) subscales preoperatively and
at the final follow-up examination.
METHODS
Spearman's correlation analysis and univariate and multivariate regression analyses
were used to examine preoperative factors that affect the JOA score recovery rate
in patients who underwent instrumentation surgery for lumbar spinal canal stenosis
at the L4/5 level due to degenerative lumbar spondylolisthesis.
RESULTS
A total of 42 patients who underwent instrumentation surgery for degenerative lumbar
spondylolisthesis and had a long-term follow-up period were included. Of these, 25
and 17 underwent posterolateral fusion and Graf stabilization, respectively. The mean
postoperative follow-up duration was 12.5 years. Spearman's correlation analysis revealed
that the long-term recovery rate was correlated with the preoperative VAS score for
low back pain. In the univariate regression analysis, sex, preoperative VAS score
for low back pain, and the SF-36 general health score were significantly associated
with the long-term recovery rate. Meanwhile, the multiple stepwise regression analysis
identified the preoperative VAS score for low back pain as an independent predictor
of the long-term recovery rate.
CONCLUSIONS
This study identified the preoperative VAS score for low back pain as an independent
predictor of the long-term recovery rate following instrumentation surgery for degenerative
lumbar spondylolisthesis. Therefore, when performing posterolateral fusion or Graf
stabilization for degenerative lumbar spondylolisthesis, attention should be paid
to the intensity of preoperative low back pain and considerations should be given
to whether these procedures can improve the patient's symptoms in the long term.
Keywords
Abbreviations:
GH (general health), JOA (Japanese Orthopedic Association), MH (mental health), PLF (posterolateral fusion), SF (social functioning), SF-36 (short-form 36), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 10, 2023
Accepted:
February 3,
2023
Received in revised form:
January 24,
2023
Received:
July 22,
2022
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: HI: Nothing to disclose. TK: Nothing to disclose. YM: Nothing to disclose. TH: Nothing to disclose. TY: Nothing to disclose. SK: Nothing to disclose. KT: Nothing to disclose. AO: Nothing to disclose.
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