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Preoperative Predictors for Postoperative Clinical Outcome in Lumbar Spinal Stenosis: Systematic Review

Aalto, Timo J., MD*†; Malmivaara, Antti, MD, DMSc; Kovacs, Francisco, MD, PhD§; Herno, Arto, MD, DMSc; Alen, Markku, MD, DMSc; Salmi, Liisa, MA, MS(Hons); Kröger, Heikki, MD, DMSc**††; Andrade, Juan, MD‡‡; Jiménez, Rosa, MD, PhD§§; Tapaninaho, Antti, MD, DMSc∥∥; Turunen, Veli, MD**; Savolainen, Sakari, MD, DMSc¶¶; Airaksinen, Olavi, MD, DMSc

doi: 10.1097/01.brs.0000231727.88477.da
Literature Review

Study Design. Systematic review.

Objective. To define preoperative factors predicting clinical outcome after lumbar spinal stenosis (LSS) surgery.

Summary of Background Data. LSS is the most common reason requiring lumbar spine surgery in adults older than 65 years. There are no published systematic reviews on this topic.

Methods. A literature search was done until April 30, 2005. Included were randomized controlled or controlled trials or prospective studies dealing with operated LSS. The preoperative predictors had to be presented. Included articles were assessed as high-quality (HQ) and low-quality studies. The predictors in HQ studies were considered as the main results.

Results. A total of 21 articles were included. Depression and walking capacity were predictors according to 2 HQ studies. Predictors reported in 1 HQ study were cardiovascular/overall comorbidity, disorder influencing walking ability, self-rated health, income, severity of central stenosis, and scoliosis.

Conclusion. Depression, cardiovascular comorbidity, disorder influencing walking ability, and scoliosis predicted poorer subjective outcome. Better walking ability, self-rated health, higher income, less overall comorbidity, and pronounced central stenosis predicted better subjective outcome. Male gender and younger age predicted better postoperative walking ability. The predictive value may be outcome specific; thus, the use of all relevant outcome measures is recommended when studying predictors of LSS.

Prospective articles studying predictors of lumbar spinal stenosis surgery were systematically reviewed. Comorbidity, functional ability, and some patient-related factors and radiologic findings do have predictive value. The predictive value may be outcome-specific; thus, the use of all relevant outcome measures is recommended in studying predictors of lumbar spinal stenosis.

From the *Department of Surgery, Kuopio University, Kuopio, Finland; †Department of the Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland; ‡Finnish Office for Health Care Technology Assessment/National Research and Development Centre for Welfare and Health, Helsinki, Finland; §Departamento Cientifico. Fundacion Kovacs. Palma de Mallorca, Spain; ∥Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland; ¶Kuopio University Library, Kuopio University Hospital Medical Library, Kuopio, Finland; **Department of Surgery/Orthopaedics, Kuopio University Hospital, Kuopio, Finland; ††Bone and Cartilage Research Unit, University of Kuopio, Kuopio, Finland; ‡‡Rehabilitation Department, Hospital de Jaen, Jaen, Spain; §§Research Department, Hospital Hermanos Ameijeiras, and Instituto Superior de Ciencias Medicas de la Habana, La Habana, Cuba; ∥∥Hospital Lasaretti, Kuopio, Finland; and ¶¶Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.

Acknowledgment date: July 6, 2005. First revision date: February 7, 2006. Acceptance date: March 30, 2006.

Supported by EVO-grant 2004, 2005 and 2006 (Kuopio University Hospital), a grant from the Finnish Cultural Foundation (Finland) and the Kovacs Foundation (Palma de Mallorca, Spain). No commercial party having a direct or indirect interest in the subject matter of this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation, Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Timo J. Aalto, MD, Department of the Physical and Rehabilitation Medicine, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland; E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.