Date: 10 Jul 2012
Prediction of long-term clinical outcome in patients with lumbar spinal stenosis
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
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.
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).
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.
Arnoldi CC, Brodsky AE, Cachoix J et al (1976) Lumbar spinal stenosis and nerve root entrapment. Syndromes, definition, and classification. Clin Orthop 115:4–5PubMed
Ciol MA, Deyo RA, Howell E, Kreif S (1996) An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 44:285–290PubMed
Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimäki T, Rönty H, Tallroth K, Turunen V, Knekt P, Härkänen T, Hurri H, Finnish Lumbar Spinal Research Group (2007) Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine 32:1–8PubMedCrossRef
Adamova B, Vohanka S, Dusek L (2003) Differential diagnostics in patients with mild lumbar spinal stenosis: the contributions and limits of various tests. Eur Spine J 12:190–196PubMed
Mičánková Adamová B, Voháňka S (2009) The results and contribution of electrophysiological examination in patients with lumbar spinal stenosis. Scr Med (Brno) 82(1):38–45
Adamova B, Bednarik J, Smardova L, Moravcova E, Chvatalova N, Prokes B, Kadanka Z (2000) The association between cervical and lumbar spinal canal stenosis (in Czech). Ces Slov Neurol Neurochir 5:261–267
Johnsson KE, Rosen I, Uden A (1992) The natural course of lumbar spinal stenosis. Clin Orthop Relat Res 279:82–86PubMed
Dhand UK, Das SK, Chopra JS (1991) Patterns of H-reflex abnormality in patients with low back pain. Electromyogr Clin Neurophysiol 31:209–213PubMed
Braddom RI, Johnson EW (1974) Standardization of H reflex and diagnostic use in S1 radiculopathy. Arch Phys Med Rehabil 55:161–166PubMed
- Prediction of long-term clinical outcome in patients with lumbar spinal stenosis
European Spine Journal
Volume 21, Issue 12 , pp 2611-2619
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Lumbar spinal stenosis
- Natural course
- Industry Sectors
- Author Affiliations
- 1. Department of Neurology, Faculty Hospital and Masaryk University Brno, Jihlavska 20, 62500, Brno, Czech Republic
- 2. CEITEC, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- 3. Institute of Biostatistics and Analyses, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic