Sex-Dependent Differences in Symptom-Related Disability Due to Lumbar Spinal Stenosis.

STUDY DESIGN: Retrospective observational study. OBJECTIVE: The objective of this study is to identify possible sex-dependent differences in symptom-related disability in patients with lumbar spinal stenosis. METHODS: 103 consecutive outpatients (42 men and 61 women) with lumbar spinal stenosis were assessed on the basis of their medical history, the physical examination, and a series of questionnaires including the Oswestry Disability Index (ODI), the Roland Morris Disability Questionnaire (RMDQ), the Patient Health Questionnaire module 9 (PHQ-9), and the Depression Anxiety Stress Scales (DASS). Narrowing of the spinal canal was graded according to the method established by Schizas. Parameters were statistically analyzed according to the biological sex of the patients. The influence of the variables on the disability scores was analyzed by means of a multivariate regression model. RESULTS: Symptom severity was equally distributed between men and women. Female patients showed higher RMDQ and ODI scores as well as significantly higher intermediate depression scores. The confounding variables age, pain chronicity, and psychological affection as well as the symptoms level of pain and paresis were dependent on patient sex. CONCLUSION: The study shows sex-depended differences in the perception of symptoms of lumbar spinal stenosis and disability of life. The findings suggest that the main mediators are pain perception and psychological influences on the quality of life.

Positive medium-term influence of multimodal pain management on socioeconomic factors and health care utilization in patients with lumbar radiculopathy: a prospective study.

BACKGROUND: Multimodal pain management (MPM) represents a central approach to avoiding surgery in patients with lumbar radiculopathy. Independent of the type of health system, cost effectiveness and socioeconomic factors are becoming increasingly important. This study investigated the medium-term influence of conservative MPM on health care utilization and socioeconomic factors. METHODS: This study compared subjective, objective, and socioeconomic factors of 60 patients after inpatient MPM because of lumbar radiculopathy, before and 1 year ± 2 weeks after treatment. RESULTS: Over the course of the 1-year follow-up, one-third of the patients had not required any conservative treatment in comparison to 100% of patients before MPM therapy. The number of patients requiring analgesics could be significantly reduced from 26 to 12, and the number of patients who did not require any analgesics had increased from 14 to 32. After 1 year, the number of patients who had to regularly contact a physician because of low back pain (once per month for 6 months) had been reduced from 58 to 27. CONCLUSION: MPM is an effective approach to treating lumbar radiculopathy and reducing its negative influence on socioeconomic factors. Therapeutic benefits also include a decrease in health care utilization. Therefore, health care providers should place the mid-term success for patients and socioeconomic factors before the short-term costs of therapy.