Does Back Pain Improve Following Lumbar Decompression Alone?

STUDY

DESIGN

Retrospective cohort study of a prospectively collected database at an academic institution.

OBJECTIVE

(1) Evaluate if low back pain (LBP) improves following decompression for neurogenic claudication or radiculopathy, (2) use the least absolute shrinkage and selection operator (LASSO) methodology to identify preoperative predictors for improvement in LBP, and (3) develop a pilot nomogram to guide clinical planning and postoperative expectations.

SUMMARY OF BACKGROUND DATA: LBP is a common complaint for patients with degenerative lumbar spine disease. Often, LBP is considered a contraindication to decompression. Anecdotally, patients with lumbar spinal stenosis (LSS) report improvements in LBP following decompression for neurogenic claudication or radiculopathy.

METHODS

Patients were analyzed that had decompressive surgery without fusion for LSS from 2017 to 2020. Patients were excluded with a tumor, infection, prior fusion, or incomplete questionnaires. Patient-reported outcome measures (PROMs), clinical variables, and radiographic variables were evaluated. Patients who achieved minimal clinically important difference (MCID) in LBP were compared with those who did not at 12-month follow-up. LASSO methodology was used to identify related predictive variables.

RESULTS

One hundred seventy-six patients were analyzed. The majority reached MCID for back pain (n=109, 61.9%). Baseline clinical and radiographic variables were comparable. Patients who achieved MCID in back pain had significantly higher preoperative pain and greater disability on PROMs. ML identified the related variables of age, BMI, VAS-B, ODI total tertile, EQ-5D, PROMIS-P, PROMIS-M, and CCI to accurately predict who will reach meaningful improvement at 12-months postoperatively (AUROC=0.832).

CONCLUSIONS

The majority experienced significant improvements in LBP following decompression for LSS. Improvers had higher preoperative pain scores and measures of disability. Back pain should not be a contraindication to decompression without fusion. A pilot version of a predictive nomogram was developed to be used in the preoperative clinic visit that can guide clinical management and surgeon/patient expectations.

LEVEL OF EVIDENCE: Level III.