Department of Orthopaedics, Sahlgren University Hospital, Gothenburg, Sweden
INTRODUCTION: Surgery has been shown to give superior results compared to natural history in lumbar spinal stenosis (LSS), although some patients are unchanged or slightly improved even without surgery. The aim of the present study was to further study natural history and factors potentially influencing clinical picture and development.
MATERIAL AND METHODS: 240 patients with clinical and radiological signs of LSS, referred for surgical evaluation answered a computerized interview including, leg and back pain (VAS, 0—100), walking distance, depressive symptoms (Zung, 0—100) and quality of life (EQ5D, ‐48—100). 146 were not selected for surgery. They were prospectively followed 3.4 years (2.1—5.2), at which time, 107 of 120 eligible were re‐evaluated. 58% were female. Mean age was 68 (21—91). 47% had two or more level stenosis. L4‐L5 was affected in 79%. Mean dural sac area was 50 mm2. 26% had a lumbar deformity and 26% had a degenerative spondylolisthesis.
RESULTS: At baseline, leg pain was 56 and back pain was 61. Walking distance was < 500m in 56%. EQ5D was 38 and Zung 38. At FU, VAS (leg and back) and EQ5D showed significant improvement (˜10 units). Comparing leg pain, 55% were unchanged, 32% improved and 13% deteriorated. Cases with lumbar deformities had more back pain (79 and 64) and less EQ5D (15 and 31) at baseline and FU. A change in pain level or EQ5D could not be predicted by degree of stenosis, number of levels affected, presence of degenerative spondylolisthesis or lumbar deformity.
DISCUSSION: The natural history of LSS from other studies is confirmed. Since worsening is rare, reluctance towards surgery in patients with tolerable levels of pain and function is warranted. Presence of a lumbar deformity implies a partially different pathology with considerably higher symptom levels. Radiological findings does not influence clinical development