PREDICTORS OF FUNCTIONAL RECOVERY FOLLOWING SURGICAL DECOMPRESSION IN LUMBAR CANAL STENOSIS: A PROSPECTIVE COHORT STUDY
DOI:
https://doi.org/10.48047/k9m71d55Keywords:
lumbar canal stenosis, decompression, Oswestry Disability Index, predictors, depression;, diabetesAbstract
Background: Decompressive surgery reliably relieves symptoms of lumbar canal stenosis (LCS), but functional recovery varies between patients. Identifying preoperative predictors of recovery would improve patient selection and counselling.
Objectives: To quantify functional improvement after surgical decompression for LCS and to identify preoperative predictors of six-month improvement in the Oswestry Disability Index (ODI).
Methods: A prospective cohort of 120 patients undergoing decompressive surgery for symptomatic LCS was assessed preoperatively and at 3 and 6 months. Outcomes were the ODI (0–100), back and leg visual analogue scale (VAS) pain and walking distance. The primary endpoint was 6-month ODI improvement; a secondary binary endpoint was meaningful recovery (≥12.8-point ODI improvement). Predictors were examined with multivariable linear regression.
Results: The cohort (mean age 64.3 ± 9.3 years; 61.7% male) improved substantially. Mean ODI fell from 54.0 ± 11.3 to 28.4 ± 10.9 (mean improvement 25.6 ± 5.9 points; p < 0.001); leg VAS fell from 7.1 ± 1.3 to 3.8 ± 1.5 and back VAS from 6.0 ± 1.4 to 3.4 ± 1.6 (both p < 0.001); mean walking distance rose from 280 ± 163 m to 886 ± 234 m. Meaningful recovery was achieved by 117 patients (97.5%). In multivariable regression (R² = 0.44), greater ODI improvement was independently predicted by higher baseline ODI (β = +0.22, p < 0.001) and was reduced by older age (β = −0.20/year, p < 0.001), diabetes (β = −3.89, p < 0.001), depression or anxiety (β = −2.88, p = 0.015), longer symptom duration (β = −0.10/month, p = 0.003) and higher BMI (β = −0.24, p = 0.035); sex, smoking and stenosis severity were not significant.
Conclusion: Surgical decompression produced large functional gains in LCS. Older age, diabetes, depression or anxiety, longer symptom duration and higher BMI predicted smaller functional recovery, whereas higher baseline disability predicted greater absolute gain — findings that support earlier surgery and attention to modifiable comorbidity
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