Predictors of surgical outcome in degenerative lumbar spinal stenosis

Study Design. A prospective, observational study. Objectives. To identify outcome predictors of surgery for degenerative lumb ar spinal stenosis. Summary of Background Data. Degenerative lumbar spinal stenosis is the most frequent indication for spine surgery in the elderly. More than 25% of sur gical patients have a poor outcome, yet little is known about factors that predict the outcome of surgery. Methods. Surgery was performed on 199 patients with degenerative lumbar spi nal stenosis, and they were observed for 2 years after surgery in four refe rral centers. Surgery consisted of decompressive laminectomy with or withou t arthrodesis. Outcomes included validated measures of symptom severity, wa lking capacity, and satisfaction with the results of surgery. Potential pre dictors of outcome included sociodemographic factors and physical examinati on, as well as radiographic, psychological, social, and clinical history va riables. Results. The proportion of patients with severe pain decreased from 81% bef ore surgery to 31% by 2 years afterward. The most powerful preoperation pre dictor of greater walking capacity, milder symptoms, and greater satisfacti on was the patient's report of good or excellent health before surgery. Low cardiovascular comorbidity also predicted a favorable outcome. Conclusions. Patients' assessments of their own health and comorbidity are the most cogent outcome predictors of surgery for spinal stenosis.