European Spine Journal

, Volume 21, Issue 12, pp 2611–2619

Prediction of long-term clinical outcome in patients with lumbar spinal stenosis

Authors

    • Department of NeurologyFaculty Hospital and Masaryk University Brno
    • CEITEC, Central European Institute of TechnologyMasaryk University
  • S. Vohanka
    • Department of NeurologyFaculty Hospital and Masaryk University Brno
    • CEITEC, Central European Institute of TechnologyMasaryk University
  • L. Dusek
    • Institute of Biostatistics and AnalysesMasaryk University
  • J. Jarkovsky
    • Institute of Biostatistics and AnalysesMasaryk University
  • J. Bednarik
    • Department of NeurologyFaculty Hospital and Masaryk University Brno
    • CEITEC, Central European Institute of TechnologyMasaryk University
Original Article

DOI: 10.1007/s00586-012-2424-7

Cite this article as:
Micankova Adamova, B., Vohanka, S., Dusek, L. et al. Eur Spine J (2012) 21: 2611. doi:10.1007/s00586-012-2424-7

Abstract

Purpose

The natural course of lumbar spinal stenosis (LSS) fluctuates and is not necessarily progressive. The aim of this study was to explore the predictors of clinical outcome in patients with LSS that might eventually help to optimise the therapeutic choices.

Methods

A group of 56 patients (27 men, 29 women, median age 55; range 31–72 years) with clinically symptomatic mild-to-moderate LSS were re-examined after a median period of 88 months and their clinical outcomes classified as satisfactory (34 patients, 60.7 % with stable or improved clinical status) or unsatisfactory (22 patients, 39.3 % for whom clinical status deteriorated). A wide range of demographical, clinical, imaging and electrophysiological entry parameters were evaluated as possible predictors of clinical outcome.

Results

Unlike the demographical, clinical and imaging variables, certain electrophysiological parameters were significantly associated with unsatisfactory outcomes. There was a significantly higher prevalence of pluriradicular involvement detected by EMG in patients with unsatisfactory outcome than those with satisfactory outcome (68.2 vs. 32.3 %; p = 0.035). Patients with unsatisfactory outcome had more frequent bilateral abnormalities of the soleus H-reflex (50.0 vs. 14.7 %; p = 0.015) and lower mean H-reflex amplitude. Multivariate logistic regression proposed two variables as mutually independent predictors of unsatisfactory outcome: EMG signs of pluriradicular involvement (OR = 3.72) and averaged soleus H-reflex amplitude ≤2.8 mV (OR = 2.87).

Conclusions

Satisfactory outcomes were disclosed in about 61 % of the patients with mild-to-moderate LSS in a 7-year follow-up. Electrophysiological abnormalities, namely the presence of pluriradicular involvement and abnormalities of the soleus H-reflex, were predictive of deterioration of clinical status in these patients.

Keywords

Lumbar spinal stenosisElectromyographyOutcomeNatural coursePrognosis

Abbreviations

LSS

Lumbar spinal stenosis

NC

Neurogenic claudication

ODI

Oswestry disability index

EMG

Electromyography

LL

Lower limb

NRS

Numerical rating scale

AP

Anteroposterior

CT

Computed tomography

MRI

Magnetic resonance imaging

ROC

Receiver operating characteristic

Copyright information

© Springer-Verlag 2012