AUTHOR=Fields Daryl P. , Holloway Kathryn Lois , Levin Emily , Keyserling Harold , Nortman Samuel , Krein Sarah L. , Gentili Amilcare , Katz Jeffrey N. , Perera Subashan , Weiner Debra K. 

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

JOURNAL=Frontiers in Musculoskeletal Disorders

VOLUME=2

YEAR=2025

URL=https://www.frontiersin.org/journals/musculoskeletal-disorders/articles/10.3389/fmscd.2024.1493642

DOI=10.3389/fmscd.2024.1493642

ISSN=2813-883X

ABSTRACT=<sec><title>Background/context</title><p>Decompressive laminectomy (DL) for lumbar spinal stenosis (LSS) is the most common spinal surgery for older adults. Biopsychosocial factors are associated with 1-year outcomes in these patients. While most surgical failures occur within 12 months, some are delayed, and factors responsible for delayed surgical failure are poorly understood.</p></sec><sec><title>Purpose</title><p>We sought to identify preoperative factors associated with long-term surgical success as defined by the Brigham Spinal Stenosis (BSS) questionnaire.</p></sec><sec><title>Study design/setting/patient sample</title><p>Within this prospective cohort study, we used logistic regression modeling to identify preoperative biopsychosocial factors that predict 4-year DL success in 110 prospectively evaluated veterans who underwent DL without fusion for LSS.</p></sec><sec><title>Outcome measures/methods</title><p>A questionnaire was used to evaluate BSS outcomes at 4 years post-DL.</p></sec><sec><title>Results</title><p>Overall, 69 participants (63%) demonstrated 4-year surgical success—sustained improvement in at least two of the three BSS domains (symptoms, function, and satisfaction). Greater catastrophizing [OR for 2 points 0.92 (0.84–1.00); <italic>p</italic> = 0.0512] and longer symptom duration [OR for 12 months 0.96 (0.93–0.99); <italic>p</italic> = 0.0231] were associated with lower likelihood of success, while presence of moderate/severe stenosis (OR 7.16–7.39; <italic>p</italic> = 0.0195–0.0260), college education [OR 2.93 (1.27–6.77); <italic>p</italic> = 0.0120], and greater treatment credibility [OR for 10 points 1.35 (1.10–1.66); <italic>p</italic> = 0.0048] were associated with greater likelihood of success in bivariate analyses. Symptom duration [OR 0.96 (0.92–0.99); <italic>p</italic> = 0.0208], treatment credibility [OR 1.51 (1.15–1.98); <italic>p</italic> = 0.0031], and stenosis severity (OR 14.4–17.4; <italic>p</italic> = 0.0045–0.0055) constituted a parsimonious set of factors in multivariable modeling.</p></sec><sec><title>Conclusions</title><p>Further work is needed to definitively identify preoperative factors that predict long-term outcomes. This may facilitate more accurate patient selection and counseling for patients undergoing DL for LSS.</p></sec>