Computed tomography findings 4 years after surgical management of lumbar spinal stenosis - No correlation with clinical outcome

Study Design. A prospective, cross-sectional study of the correlation betwe en postoperative computed tomography findings and patients' clinical outcom es approximately 4 years after laminectomy for lumbar spinal stenosis. Objectives. To evaluate clinical and radiologic characteristics and their r elation to each other. Summary of Background Data. The goal of surgical management for lumbar spin al stenosis is to decompress the stenotic area determined in radiologic exa minations to relieve pressure on the neurovascular structures. However, the success of this decompression very rarely has been confirmed by postoperat ive radiologic imaging or compared with clinical outcome. Methods. Postoperative computed tomography was performed on 191 patients. T he findings were classified as "no stenosis," "Central stenosis," "lateral stenosis," or "central-lateral stenosis." Postoperative instability of the lumbar spine was investigated by functional radiography. Clinical status wa s assessed by clinical examination. Subjective disability was assessing usi ng the Oswestry questionnaire, and severity of pain using the visual analog scale. Walking capacity was evaluated by the treadmill test. Results. Radiologic studies revealed postoperative stenosis in 123 patients (64%). Small differences between the computed tomography groups were shown for the Oswestry score, but not for walking distance. Clinical signs, seve rity of pain, and radiologic instability were very similar for all computed tomography groups. Conclusions. Postoperative radiologic stenosis was very common in patients operated on for lumbar spinal stenosis, but this did not correlate with cli nical outcome. The clinician must be cautious when reconciling clinical sym ptoms and signs with postoperative computed tomography findings in patients operated on for lumbar spinal stenosis.