Understanding the complexity of surgical decision-making for individuals with symptomatic lumbar spinal stenosis: A qualitative study.

BACKGROUND

Understanding the factors influencing surgical decisions specific to symptomatic lumbar spinal stenosis (SLSS) can help healthcare providers support patients, set expectations and improve health literacy. Therefore, the purpose of this study is to explore the experiences and perspectives of Canadian patients who choose to undergo surgery for SLSS.

METHODS

We used qualitative interpretive phenomenology to understand the surgical decision-making process from individuals with lived experience of SLSS. We conducted semi-structured qualitative interviews that lasted between 30 and 90 min. Inclusion criteria were individuals 55 or older, diagnosed with SLSS, scheduled for or have undergone lumbar spine surgery, and able to speak English. Participants were recruited between October 2019 and September 2021.

RESULTS

A total of 32 participants (Men: n = 18; Women: n = 14) were included in this study. Among those participants, 15 were interviewed preoperatively and 17 postoperatively, and all were over 55 years. We identified 5 themes that were woven through the decision-making of respondents, beginning with the experience with healthcare systems and building outwards to the broader social context: (1) Previous experience with non-surgical management, (2) Worrisome symptoms impacting functionality, (3) Perception of surgery as a final course of action, (4) Post-surgical hopes/expectations (i.e., hope that they will be pain-free after surgery), and (5) Having a social support network (i.e., advice and support from family/friends).

CONCLUSION

Several experiences may influence an individual's decision to undergo spine surgery, highlighting the importance of integrating a biopsychosocial model in managing SLSS. For chiropractors and manual therapists, these indicators are particularly important, as they often represent a first point of contact for patients with SLSS. Clinicians must maintainperson-centric communication to help patients understand their condition and the clinical treatment pathway for SLSS and develop post-surgical expectations.