A study led by Nils H Ulrich, Department of Orthopaedics, University Hospital Balgrist, University of Zurich, Switzerland, shows that degenerative lumbar spinal stenosis (DLSS) patients aged 80 and above could see significant clinical improvements following lumbar decompression surgery without fusion. The study was published ahead-of-print in the journal Spine.
The authors note that there is still confusion about the overall management strategies for older patients suffering from DLSS, and that existing literature “lacks evidence on diagnosis and treatment” of the condition in this demographic. Given the ageing population in much of the world–the study states that the US proportion of population aged 65 and over is predicted to increase from 12% in 2000 to 20% in 2030–Ulrich and colleagues suggest that surgeons will increasingly face a wide variety of degenerative changes of the lumbar spine, necessitating an improved understanding of the condition and its treatment.
The study involved eight centres in the Zurich area of Switzerland, which first agreed on the classification of DLSS, surgical principles and follow-up protocols. Patients were followed from baseline, at six months and at 12 months. The patients’ baseline characteristics were analysed with five different questionnaires: cumulative illness rating scale (CIRS), spinal stenosis measure (SSM), feeling thermometer and numeric rating scale (NRS), EQ-5D-3L and the Roland and Morris disability questionnaire. Results of these questionnaires were then compared to those of a younger control group (average age of 75±2.6). Minimal clinical important differences (MCID) were also calculated.
Thirty-seven patients (average age of 82.5±2.5 years) reached the 12 month follow-up. Patients selected were all a minimum of 80 years old with a history of neurogenic claudication, who had not undergone previous lumbar spine surgery and who did not respond to conservative treatment. Though one EQ-5D-3L subgroup (anxiety/depression) showed no significant improvement (p=0.019), all other subgroups and questionnaires showed a significant improvement at 12 months follow-up (p<0.001). In the 12 months follow-up, the authors note that “70.6% of our patients experienced a clinical meaningful improvement in the symptom severity scale. In the physical function scale, 64.7% experienced a clinical meaningful improvement in the 12 month follow-up.”
The two groups, >80 years and <80 years, had a similar CIRS score at baseline of 9.9±4.1 and 9.7±4.2 (p=0.87) respectively. At six month follow-up the authors found one significantly different (p<0.001) subgroup between the two groups in the EQ-5D-3L (pain/discomfort). At 12 month follow-up, the EQ-5D-3L for pain/discomfort (p=0.012) and EQ-5D-3L for actual health (p=0.003) showed significant differences between the two groups. The authors conclude: “In comparison to our younger control group our results point to similar potential for clinical improvement after simple decompression without fusion and our patient population confirms significant positive development in quality of life in the short- and long-term follow-ups.”