The influence of the lumbar spinal stenosis severity and extent on clinical symptoms and functional outcomes of surgical treatment

Objective. To evaluate the influence of the grade and extent of lumbar spinal stenosis on the severity of clinical symptoms before surgical treatment and the functional status of patients after surgery.
Material and Methods. A retrospective monocentric study was conducted including 380 patients with clinically significant degenerative central lumbar stenosis. The grade of spinal canal stenosis was determined using MRI data (according to the Schizas and Lee – Guen classifications). The number of affected spinal segments was also studied. The functional status before and after surgery was assessed using the ODI questionnaire, and pain – using the VAS. The dynamics of clinical changes after surgery was followed-up in 76 patients from the general cohort who agreed to participate in a survey or came for a follow-up examination.
Results. After comparing the Oswestry and VAS scores in groups of patients with different grades of Schizas and Lee – Guen stenosis severity, no statistically significant differences were noted (p = 0.325, p = 0.498, and p = 0.634, respectively). Statistically significant differences in the number of affected segments were also not revealed (p = 0.281 for Oswestry and p = 0.664 for VAS). When assessing the correlation between the extent of stenosis and questionnaire scores, a weak direct relationship was found between Oswestry scores after surgery and the number of affected segments (rho = 0.357, p = 0.015). Construction of linear regression revealed that patients with one and two affected segments vary significantly in outcomes (p = 0.039, 95 % CI [0.734; 2.65]), while other cases showed no statistically significant difference.
Conclusion. The conducted study showed no statistically significant relationship between the severity of lumbar stenosis, as assessed according to the Schizas and Lee – Guen classifications, the number of affected segments and clinical symptoms in patients. It was also found that the severity of the stenosis does not affect the outcome of surgery, while the functional outcomes after surgery for patients with one or two affected segments may differ significantly in terms of statistics.  

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