The clinical course of pain and disability following surgery for spinal stenosis: a systematic review and meta-analysis of cohort studies
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The aim of this study was to assess the clinical course of pain and disability in patients with lumbar spinal stenosis following surgery.
Electronic databases were searched to July 2014 and only prospective cohort studies assessing pain or disability following surgery for lumbar spinal stenosis were included. Two independent reviewers extracted data and assessed study quality. Estimates of pain and disability (expressed as 0–100 point scales) as well as 95 % confidence intervals were obtained using meta-regression. The effect of time was clearly non-linear, so it was modelled using fractional polynomial regression.
From a total of 10,741 titles, 69 publications (64 cohort studies) were included in the review. Pooled estimate for pain pre-operatively was 63.4 (95 % CI 56.5; 70.3), reducing to 33.1 (95 % CI 24.2; 41.9) at 3 months and 19.2 points (95 % CI 9.2; 29.3) at 60 months. Pre-operative estimates of disability were 36.9 (95 % CI 32.6; 41.3), reducing to 16.3 (95 % CI 11.8; 20.9) at 3 months and 12.4 (95 % CI 7.7; 17.2) at 60 months.
Patients with lumbar spinal stenosis experience rapid symptom reduction after surgery, but should still expect to experience mild-to-moderate pain and disability 60 months later.
KeywordsLumbar spinal stenosis Meta-analysis Prognosis Surgery
MLF is a Sydney Medical Foundation Fellow/Sydney Medical School, CGM is supported by the Australian Research Council, and RDH is supported by the National Health and Medical Research Council of Australia.
Compliance with ethical standards
Conflict of interest
All authors have no conflict of interest. Authors have full control of all primary data and agree to allow the journal to review their data if requested.
- 2.Comer CM, Redmond AC, Bird HA, Conaghan PG (2009) Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists. BMC Musculoskel Disord 10:121. doi: 10.1186/1471-2474-10-121 CrossRefGoogle Scholar
- 3.Winter CC, Brandes M, Muller C, Schubert T, Ringling M, Hillmann A, Rosenbaum D, Schulte TL (2010) Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study. BMC Musculoskelet Disord 11:233. doi: 10.1186/1471-2474-11-233 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Otani K, Kikuchi S, Yabuki S, Igarashi T, Nikaido T, Watanabe K, Konno S (2013) Lumbar spinal stenosis has a negative impact on quality of life compared with other comorbidities: an epidemiological cross-sectional study of 1862 community-dwelling individuals. Sci World J 2013:590652. doi: 10.1155/2013/590652 CrossRefGoogle Scholar
- 5.Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2013) Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthr Cartil OARS 21(6):783–788. doi: 10.1016/j.joca.2013.02.656 CrossRefGoogle Scholar
- 30.Aalto TJ, Malmivaara A, Kovacs F, Herno A, Alen M, Salmi L, Kroger H, Andrade J, Jimenez R, Tapaninaho A, Turunen V, Savolainen S, Airaksinen O (2006) Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine 31(18):E648–E663. doi: 10.1097/01.brs.0000231727.88477.da CrossRefPubMedGoogle Scholar
- 47.Endres S (2011) Instrumented posterolateral fusion - clinical and functional outcome in elderly patients. Ger Med Sci 9:Doc09Google Scholar
- 66.Paker N, Turkmen C, Bugdayci D, Tekdos D, Erbil M (2005) Comparison of conservative and surgical treatment results in lumbar spinal stenosis. Turk Neurosurg 15:182–184Google Scholar
- 87.Wong Chung-Ting M, Chan Pak-Ho A, Cheung KK (2012) A prospective study on the outcome of degenerative lumbar spinal stenosis treated with open laminotomy. J Orthop Trauma Rehab 16:62–65Google Scholar
- 91.Yucesoy K, Ozer E (2002) Inverse laminoplasty for the treatment of lumbar spinal stenosis. Spine 27:E316–E320Google Scholar
- 92.Yukawa Y, Lenke LG, Tenhula J, Bridwell KH, Riew KD, Blanke K (2002) A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. J Bone Joint Surg 84-A:1954–1959Google Scholar