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ORIGINAL RESEARCH article

Front. Musculoskelet. Disord.
Sec. Spine Conditions
Volume 2 - 2024 | doi: 10.3389/fmscd.2024.1493642

Preoperative factors and four-year decompressive laminectomy success in symptomatic lumbar spinal stenosis

Provisionally accepted
Daryl Pinion Fields Daryl Pinion Fields 1*Kathryn Lois Holloway Kathryn Lois Holloway 2,3Emily Levin Emily Levin 4,5Harold Keyserling Harold Keyserling 6,7Samuel Nortman Samuel Nortman 8,9Sarah L Krein Sarah L Krein 10Amilcare Gentili Amilcare Gentili 11Jeffrey N Katz Jeffrey N Katz 12,13,14Subashan Perera Subashan Perera 15,16Debra Weiner Debra Weiner 15
  • 1 University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • 2 Hunter Holmes McGuire VA Medical Center, United States Department of Veterans Affairs, Richmond, Virginia, United States
  • 3 Virginia Commonwealth University, Richmond, Virginia, United States
  • 4 VA Ann Arbor Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Ann Arbor, Michigan, United States
  • 5 University of Michigan, Ann Arbor, Michigan, United States
  • 6 Emory University, Atlanta, Georgia, United States
  • 7 Atlanta VA Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Decatur, Georgia, United States
  • 8 University of Colorado Boulder, Boulder, Colorado, United States
  • 9 VA Eastern Colorado Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Denver, Colorado, United States
  • 10 VA Medical Center Ann Arbor Research Service, Ann Arbor, Michigan, United States
  • 11 VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, California, United States
  • 12 Harvard Medical School, Boston, Massachusetts, United States
  • 13 Harvard Chan School Center for Work, Health, and Well-being, School of Public Health, Harvard University, Boston, Massachusetts, United States
  • 14 Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • 15 School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • 16 School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

The final, formatted version of the article will be published soon.

    Background/Context: Decompressive laminectomy (DL) for lumbar spinal stenosis (LSS) is the most common spinal surgery for older adults. Biopsychosocial factors are associated with one-year outcomes in these patients. While most surgical failures occur within twelve-months, some are delayed and factors responsible for delayed surgical failure are poorly understood. Purpose: We sought to identify preoperative factors associated with long-term surgical success as defined by the Brigham Spinal Stenosis (BSS) questionnaire. Study Design/Setting/Patient Sample: Within this prospective cohort study we used logistic regression modeling to identify pre-operative biopsychosocial factors that predict four-year DL success in 110 prospectively evaluated veterans who underwent DL without fusion for LSS. Outcome Measures/Methods: A questionnaire was used to evaluate BSS Spinal Stenosis outcomes at four-years post DL. Results: Overall, 69 participants (63%) demonstrated four-year surgical success -sustained improvement in at least 2 of the 3 BSS domains (symptoms, function, and satisfaction). Greater catastrophizing (OR for 2 points 0.92 [0.84-1.00]; p=0.0512) and longer symptom duration (OR for twelve-months 0.96 [0.93-0.99]; p=0.0231) were associated with lower likelihood of success, while presence of moderate/severe stenosis (OR 7.16-7.39; p=0.0195-0.0260), college education (OR 2.93 [1.27-6.77]; p=0.0120) and greater treatment credibility (OR for 10 points 1.35 [1.10-1.66]; p=0.0048) with greater likelihood of success in bivariate analyses. Symptom duration (OR 0.96 [0.92-0.99]; p=0.0208), treatment credibility (OR 1.51 [1.15-1.98]; p=0.0031) and stenosis severity (OR 14.4-17.4; p=0.0045-0.0055) constituted a parsimonious set of factors in multivariable modeling. Conclusions: Further work is needed to definitively identify pre-operative factors that predict long-term outcomes. This may facilitate more accurate patient selection and counseling for patients undergoing DL for LSS.

    Keywords: Lumbar spinal stenosis, Decompressive laminectomy, long-term follow-up, function, symptom, Veterans, Lumbar stenosis

    Received: 09 Sep 2024; Accepted: 19 Nov 2024.

    Copyright: © 2024 Fields, Holloway, Levin, Keyserling, Nortman, Krein, Gentili, Katz, Perera and Weiner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Daryl Pinion Fields, University of Pittsburgh, Pittsburgh, 15260, Pennsylvania, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.