Association between preoperative activity level and functional outcome at 12 months following surgical decompression for lumbar spinal stenosis.

OBJECTIVE: This study defines the association of preoperative physical activity level with functional outcomes at 3 and 12 months following surgical decompression for lumbar spinal stenosis. METHODS: Data were collected as a prospective observational registry at a single institution from 2012 through 2015, and then analyzed with a retrospective cohort design. Patients who were able to participate in activities outside the home preoperatively were compared to patients who did not participate in such activities, with respect to 3-month and 12-month functional outcomes postintervention, adjusted for relevant confounders. RESULTS: Ninety-nine patients were included. At baseline, sedentary/inactive patients (n = 55) reported greater back pain, lower quality of life, and higher disability than similarly treated patients who were active preoperatively. Both cohorts experienced significant improvement from baseline in back pain, leg pain, disability, and quality of life at both 3 and 12 months after lumbar decompression surgery. At 3 months postintervention, sedentary/inactive patients reported more leg pain and worse disability than patients who performed activities outside the home preoperatively. However, at 12 months postintervention, there were no statistically significant differences between the two cohorts in back pain, leg pain, quality of life, or disability. Multivariate analysis revealed that sedentary/inactive patients had improved disability and higher quality of life after surgery compared to baseline. Active patients experienced greater overall improvement in disability compared to inactive patients. CONCLUSIONS: Sedentary/inactive patients have a more protracted recovery after lumbar decompression surgery for spinal stenosis, but at 12 months postintervention can expect to reach similar long-term outcomes as patients who are active/perform activities outside the home preoperatively.

Obese (Body Mass Index >30) Patients Have Greater Functional Improvement and Reach Equivalent Outcomes at 12 Months Following Decompression Surgery for Symptomatic Lumbar Stenosis.

OBJECTIVE: To evaluate effect of obesity on 12-month functional outcomes after surgery for lumbar stenosis in adult patients. METHODS: Data were collected on patients treated with lumbar laminectomy for symptomatic lumbar spinal stenosis as part of an observational registry and analyzed using a retrospective cohort study design. Patients with body mass index (BMI) >30 were compared with patients with BMI <30 with respect to baseline, 3-month, and 12-month functional status, adjusted for potential confounders. RESULTS: There were 101 patients. At baseline, patients with BMI >30 had significantly more back pain (P < 0.001), more leg pain (P < 0.001), lower EuroQol 5 dimensions questionnaire (EQ-5D) scores (P < 0.001), and higher Oswestry Disability Index (ODI) scores (P < 0.001). Both low- and high-BMI groups had significant improvement in back pain, leg pain, EQ-5D scores, and ODI scores after decompression (all P < 0.001). At 3 months postoperatively, high-BMI patients continued to report greater leg pain (P = 0.063) and higher ODI score (P = 0.064) relative to low-BMI patients. By 12 months, there was no difference between low- and high-BMI patients in back pain (P = 0.929), leg pain (P = 0.638), EQ-5D score (P = 0.733), or ODI score (P = 0.214). CONCLUSIONS: The difference between low- and high-BMI patients trended toward significance for leg pain and ODI score at 3 months, but this difference disappeared by 12 months. This suggests that obese patients with symptomatic lumbar spinal stenosis may require longer to recover after decompression but can expect to reach equivalent outcomes of similarly treated patients with BMI <30.