Effect of the Treatment of Low Back Pain by Decompression for Lumbar Spinal Stenosis

Abstract

Introduction: We examined the preoperative predictors of lower back pain relief by decompression for lumbar spinal stenosis.

Methods: We analyzed 148 patients who underwent decompression using lumbar spinous process-splitting laminectomy for lumbar spinal stenosis complicated by lower back pain. They consisted of 90 male and 58 female patients with a mean age of 72 years, and the mean observation period was 305 days. Of these patients, 113 with improved preoperative visual analog scale (VAS) scores for lower back pain at final observation were classified as the R group, while 35 with no improvement were classified as the NR group; we compared both groups.

Results: The R and the NR groups had the following respective characteristics: 71 and 19 male patients, mean ages of 71.3 and 72.9 years, mean numbers of decompressed intervertebral segments of 2.2 and 2.1 segments, 37 and 8 patients with slips, 15 and 6 patients with degenerative scoliosis, 27 and 12 patients with modic changes, and 36 and 6 patients with sacroiliac joint degeneration, with no significant differences between both groups. The respective mean preoperative Japanese Orthopedic Association scores were 21.6 and 14.1 points, the mean preop VAS scores for lower back pain were 66.2 and 46.4 mm, the mean preoperative VAS scores for lower limb pain were 72.1 and 55.8 mm, and the mean preop VAS scores for lower limb numbness were 67.3 and 54.7 mm, with a significant difference in preoperative VAS for lower back pain and for lower limb pain. No significant difference was found in any of the items of the preoperative Japanese Orthopedic Association Back Pain Evaluation Questionnaire. With regard to preoperative spinopelvic parameters, the respective mean pelvic incidence (PI) were 50.4° and 50.3°, the mean pelvic tilts were 23.4° and 21.2°, the mean sacral slopes were 26.9° and 29.1°, the mean lumbar lordosis (LL) angles were 35.7° and 38.1°, the mean thoracic kyphosis angles were 25.5° and 24.6°, the mean PI-LL were 14.7° and 12.2°, the mean sagittal vertical axes were 53.3 and 53.9 mm, and the mean distance between the C7 plumb line and the central sacral vertical line were 2.9 and 0.9 mm to the right, with no significant differences.

Conclusions: Decompression for lumbar spinal stenosis may relieve lower back pain if the preoperative VAS score for lower back pain is high.