Skip to main content

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



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.

This is a preview of subscription content, access via your institution.

Fig. 1



Lumbar spinal stenosis


Neurogenic claudication


Oswestry disability index




Lower limb


Numerical rating scale




Computed tomography


Magnetic resonance imaging


Receiver operating characteristic


  1. Arnoldi CC, Brodsky AE, Cachoix J et al (1976) Lumbar spinal stenosis and nerve root entrapment. Syndromes, definition, and classification. Clin Orthop 115:4–5

    PubMed  Google Scholar 

  2. Siebert E, Prüss H, Klingebiel R, Failli V, Einhäupl KM, Schwab JM (2009) Lumbar spinal stenosis: syndrome, diagnostics and treatment. Nat Rev Neurol 5:392–403 (Review)

    PubMed  Article  Google Scholar 

  3. Turner JA, Ersek M, Herron L, Deyo R (1992) Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17:1–8

    PubMed  Article  CAS  Google Scholar 

  4. Benoist M (2002) The natural history of lumbar degenerative spinal stenosis. Joint Bone Spine 69:450–457

    PubMed  Article  Google Scholar 

  5. 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 44:285–290

    PubMed  CAS  Google Scholar 

  6. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H, SPORT Investigators (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810

    PubMed  Article  CAS  Google Scholar 

  7. 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 32:1–8

    PubMed  Article  Google Scholar 

  8. Slätis P, Malmivaara A, Heliövaara M, Sainio P, Herno A, Kankare J, Seitsalo S, Tallroth K, Turunen V, Knekt P, Hurri H (2011) Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial. Eur Spine J 20:1174–1181

    PubMed  Article  Google Scholar 

  9. Hurri H, Slätis P, Soini J, Tallroth K, Alaranta H, Laine T, Heliövaara M (1998) Lumbar spinal stenosis: assessment of long-term outcome 12 years after operative and conservative treatment. J Spinal Disord 11:110–115

    PubMed  Article  CAS  Google Scholar 

  10. Simotas AC, Dorey FJ, Hansraj KK, Cammisa F Jr (2000) Nonoperative treatment for lumbar spinal stenosis. Clinical and outcome results and a 3-year survivorship analysis. Spine 25:197–203

    PubMed  Article  CAS  Google Scholar 

  11. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE (2000) Surgical and non surgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine 25:556–562

    PubMed  Article  CAS  Google Scholar 

  12. Haig AJ, Tong HC, Yamakawa KS, Parres C, Quint DJ, Chiodo A, Miner JA, Phalke VC, Hoff JT, Geisser ME (2006) Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain. Spine 31:2950–2957

    PubMed  Article  Google Scholar 

  13. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F (2000) Lumbar spinal stenosis: conservative or surgical management? A prospective 10-year study. Spine 25:1424–1435

    PubMed  Article  CAS  Google Scholar 

  14. 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 12:190–196

    PubMed  CAS  Google Scholar 

  15. Adamova B, Vohanka S, Dusek L (2005) Dynamic electrophysiological examination in patients with lumbar spinal stenosis: is it useful in clinical practice? Eur Spine J 14:269–276

    PubMed  Article  CAS  Google Scholar 

  16. 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

    Google Scholar 

  17. Egli D, Hausmann O, Schmid M et al (2007) Lumbar spinal stenosis: assessment of cauda equina involvement by electrophysiological recordings. J Neurol 254:741–750

    PubMed  Article  CAS  Google Scholar 

  18. Haig AJ, Geisser ME, Tong HC, Yamakawa KS, Quint DJ, Hoff JT, Chiodo A, Miner JA, Phalke VV (2007) Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms. J Bone Joint Surg Am 89:358–366

    PubMed  Article  Google Scholar 

  19. Wilbourn AJ, Aminoff MJ (1998) AAEM minimonograph 32: the electrodiagnostic examination in patients with radiculopathies. Muscle Nerve 21:1612–1631

    PubMed  Article  CAS  Google Scholar 

  20. 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

    Google Scholar 

  21. Johnsson KE, Rosen I, Uden A (1992) The natural course of lumbar spinal stenosis. Clin Orthop Relat Res 279:82–86

    PubMed  Google Scholar 

  22. Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25:2940–2952 Discussion 2952

    PubMed  Article  CAS  Google Scholar 

  23. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 30:936–943

    PubMed  Article  Google Scholar 

  24. Dhand UK, Das SK, Chopra JS (1991) Patterns of H-reflex abnormality in patients with low back pain. Electromyogr Clin Neurophysiol 31:209–213

    PubMed  CAS  Google Scholar 

  25. Aiello I, Rosati G, Serra G, Manca M (1981) The diagnostic value of H-index in S1 root compression. J Neurol Neurosurg Psychiatry 44:171–172

    PubMed  Article  CAS  Google Scholar 

  26. Braddom RI, Johnson EW (1974) Standardization of H reflex and diagnostic use in S1 radiculopathy. Arch Phys Med Rehabil 55:161–166

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to B. Micankova Adamova.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Micankova Adamova, B., Vohanka, S., Dusek, L. et al. Prediction of long-term clinical outcome in patients with lumbar spinal stenosis. Eur Spine J 21, 2611–2619 (2012).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Lumbar spinal stenosis
  • Electromyography
  • Outcome
  • Natural course
  • Prognosis