Zwężenie kanału kręgowego
Rokowania, prognozy i postęp choroby
Zwężenie kanału kręgowego jest powszechną przyczyną operacji kręgosłupa u osób starszych, charakteryzującą się zmiennym przebiegiem, który nie zawsze jest progresywny. Leczenie zachowawcze pozwala wielu pacjentom na utrzymanie aktywności fizycznej i dobrej jakości życia, jednak około 66% pacjentów operowanych doświadcza poprawy klinicznej. Długoterminowe wskaźniki sukcesu operacji wahają się od 45% do 72%, zależnie od parametrów takich jak ból, zdolność chodzenia, objawy neurologiczne i zdolność do pracy. Niezadowalające wyniki obserwuje się u ponad 25% pacjentów, a czynniki predykcyjne wyniku operacji obejmują m.in. samoocenę stanu zdrowia przed zabiegiem, niską współchorobowość sercowo-naczyniową, czas trwania objawów, stosunek bólu pleców do bólu nóg, palenie tytoniu, wcześniejsze operacje kręgosłupa oraz wyniki badań elektrofizjologicznych (np. obecność zajęcia wielokorzeniowego i nieprawidłowości odruchu H mięśnia płaszczkowatego). Radiologiczne cechy zwężenia, takie jak ciężkie zwężenie otworów międzykręgowych, mogą negatywnie wpływać na poprawę w skali Oswestry Disability Index (OR 0,22; 95% CI 0,06-0,83; p=0,03).
Prognoza w zwężeniu kanału kręgowego – wprowadzenie
Zwężenie kanału kręgowego jest jedną z najczęstszych przyczyn operacji kręgosłupa u osób starszych i może znacząco wpływać zarówno na aktywność fizyczną, jak i jakość życia pacjentów.1 Choroba ta charakteryzuje się przebiegiem zmiennym, który nie zawsze musi postępować.2 Naturalny przebieg zwężenia kanału kręgowego może ulegać wahaniom i nie jest koniecznie progresywny, co ma istotne znaczenie przy rozważaniu różnych metod leczenia i przewidywaniu ich skuteczności.3
W większości przypadków prognoza dla pacjentów ze zwężeniem kanału kręgowego jest dobra. Wielu pacjentów może prowadzić pełne i aktywne życie przy zastosowaniu leczenia zachowawczego, bez konieczności interwencji chirurgicznej. Należy jednak pamiętać, że zwężenie kanału kręgowego wpływa na każdego pacjenta w odmienny sposób, dlatego nie każda metoda leczenia będzie skuteczna u wszystkich pacjentów.4
Wyniki leczenia chirurgicznego
Istnieją dowody wskazujące, że leczenie operacyjne poprawia stan około dwóch trzecich pacjentów z zwężeniem kanału kręgowego.5 Długoterminowe wskaźniki powodzenia operacji wahają się między 45% a 72%, w zależności od mierzonych parametrów klinicznych (ból, zdolność chodzenia, objawy neurologiczne, zdolność do pracy).6 Jednocześnie ponad 25% pacjentów operowanych doświadcza niezadowalających wyników leczenia, a wiedza na temat czynników, które przewidują wynik operacji, jest wciąż ograniczona.7
Badania porównujące skuteczność leczenia operacyjnego i nieoperacyjnego nie dają jednoznacznych wyników. Jeden z przeglądów systematycznych wykazał brak różnic w niepełnosprawności związanej z bólem między leczeniem operacyjnym a nieoperacyjnym po 3, 6 i 12 miesiącach, przy czym tylko jedno z pięciu badań wykazało różnicę na korzyść operacji.8 Z drugiej strony, operacja jest często przedstawiana jako najbardziej skuteczna metoda leczenia zwężenia kanału kręgowego, gdy wynik definiuje się jako zmniejszenie bólu i niepełnosprawności oraz poprawę jakości życia.9
Predyktory powodzenia leczenia operacyjnego
Wynik leczenia operacyjnego zależy od wielu różnych czynników.10 Najsilniejszym przedoperacyjnym predyktorem większej zdolności chodzenia, łagodniejszych objawów i większego zadowolenia jest ocena pacjenta dotycząca dobrego lub doskonałego stanu zdrowia przed operacją.11 Niska współchorobowość sercowo-naczyniowa również przewiduje korzystny wynik.12 Oceny pacjentów dotyczące ich własnego zdrowia i współchorobowości są najbardziej przekonującymi predyktorami wyniku operacji w przypadku zwężenia kanału kręgowego.13
Wśród czynników związanych z wynikiem operacji zwężenia kanału kręgowego wymienia się również: czas trwania objawów, większy ból pleców w stosunku do bólu nóg, palenie tytoniu, wcześniejsze operacje kręgosłupa, przedoperacyjną funkcję, samoocenę zdrowia, dochód, współchorobowość i czynniki psychospołeczne.14
Szczególnie istotne są badania elektrofizjologiczne. W badaniu z siedmioletnim okresem obserwacji wykazano, że nieprawidłowości elektrofizjologiczne, a mianowicie obecność zajęcia wielokorzeniowego i nieprawidłowości odruchu H mięśnia płaszczkowatego, były predykcyjne dla pogorszenia stanu klinicznego u pacjentów z łagodnym do umiarkowanego zwężeniem kanału kręgowego.15
Radiologiczne czynniki prognostyczne
Badania wskazują na zróżnicowany wpływ czynników radiologicznych na wyniki leczenia operacyjnego. W jednym z badań wykazano, że typ zwężenia oparty na morfologii obrazu rezonansu magnetycznego nie jest wskaźnikiem wyniku operacji u pacjentów ze zwężeniem kanału kręgowego w obserwacji rocznej.16 Nie zaobserwowano różnic w wynikach operacji między typami morfologicznymi w obrazowaniu MRI u pacjentów ze zwężeniem kanału kręgowego po rocznej obserwacji. Dlatego typ zwężenia może nie być przedoperacyjnym predyktorem sukcesu chirurgicznego.17
Z drugiej strony, niektóre badania wskazują na znaczenie konkretnych cech radiologicznych. W jednym z badań wykryto istotny związek między ciężkim zwężeniem otworów międzykręgowych a mniejszą szansą osiągnięcia docelowej 30% poprawy w skali ODI (Oswestry Disability Index) po operacji: OR 0,22 (95% CI 0,06, 0,83), p=0,03.18 U pacjentów operowanych za pomocą mikrochirurgicznej dekompresji tylnej z powodu zwężenia kanału kręgowego, przedoperacyjne ciężkie zwężenie otworów międzykręgowych było związane z wyższym odsetkiem pacjentów z mniej niż 30% poprawą w ODI.19
Długoterminowa prognoza
Badania długoterminowe dotyczące przebiegu zwężenia kanału kręgowego dostarczają cennych informacji. W jednym z badań z medianą okresu obserwacji wynoszącą 88 miesięcy, zadowalające wyniki ujawniono u około 61% pacjentów z łagodnym do umiarkowanego zwężeniem kanału kręgowego.20 Grupa 56 pacjentów (27 mężczyzn, 29 kobiet, mediana wieku 55 lat; zakres 31-72 lata) z klinicznie objawowym łagodnym do umiarkowanego zwężeniem kanału kręgowego została ponownie zbadana po medianie 88 miesięcy, a ich wyniki kliniczne sklasyfikowano jako zadowalające (34 pacjentów, 60,7% ze stabilnym lub poprawionym stanem klinicznym) lub niezadowalające (22 pacjentów, 39,3%, u których stan kliniczny uległ pogorszeniu).21
Wpływ osteoporozy na prognozę
Ważnym aspektem prognozy w zwężeniu kanału kręgowego jest wpływ chorób współistniejących, takich jak osteoporoza. Badania pokazują, że nie ma istotnej różnicy w wynikach klinicznych instrumentacji kręgosłupa lędźwiowego z powodu zwężenia kanału kręgowego u pacjentów z osteoporozą i bez niej.22 Ze względu na wysoki koszt specyficznych instrumentacji opracowanych dla pacjentów z osteoporozą i ich niedostępność dla wszystkich pacjentów, wydaje się, że użycie konwencjonalnej instrumentacji wraz z kompleksowym leczeniem osteoporozy może pomóc poprawić kliniczny wynik operacji u tych pacjentów.23
Wykorzystanie uczenia maszynowego w prognozowaniu
Nowoczesne technologie, takie jak uczenie maszynowe (ML), oferują nowe możliwości w przewidywaniu wyników leczenia zwężenia kanału kręgowego. Miary wyników zgłaszanych przez pacjentów (PROMs) po operacji dekompresyjnej ze względu na zwężenie kanału kręgowego wykazują znaczną heterogeniczność, dlatego zindywidualizowane narzędzia prognostyczne mogą zapewnić cenne informacje do podejmowania wspólnych decyzji.24
Przedoperacyjne przewidywanie szeregu klinicznie istotnych punktów końcowych w chirurgii dekompresyjnej przy użyciu ML jest wykonalne i może umożliwić lepszą świadomą zgodę pacjenta oraz personalizowane, wspólne podejmowanie decyzji. Dostęp do zindywidualizowanych przedoperacyjnych analiz predykcyjnych dotyczących wyników i ryzyka leczenia może stanowić kolejny krok w ewolucji opieki chirurgicznej dla pacjentów ze zwężeniem kanału kręgowego.25
Przykłady zastosowania uczenia maszynowego
Opracowany model oparty na ML umożliwił przewidywanie przedłużonego pobytu w szpitalu z dokładnością 77% i AUC (ang. Area Under the Curve) 0,58.26 Reoperacje ogólne i reoperacje na poziomie indeksu były przewidywane odpowiednio z 69% i 63% dokładnością oraz z AUC 0,66 i 0,61.27 Modele te były w stanie przewidzieć punkty końcowe z zadowalającą wydajnością podczas wewnętrznej walidacji, wykorzystując łatwo dostępne dane przedoperacyjne.28
Innym przykładem zastosowania ML jest ekstrakcja wartościowych i interpretowalnych cech radiomicznych z kanału kręgowego przy użyciu obrazów mielografii tomografii komputerowej (CTM) i dokładne przewidywanie poziomów dekompresji u pacjentów ze zwężeniem kanału kręgowego.29 Klasyfikator EmbeddingLSVC_SVM ma potencjał, aby pomóc w procesach podejmowania decyzji chirurgicznych w praktyce klinicznej, ponieważ wykazał wysoką dyskryminację, korzystną kalibrację i korzystną użyteczność w wyborze poziomów dekompresji u pacjentów ze zwężeniem kanału kręgowego przy użyciu cech radiomicznych kanału z CTM.30
Podsumowanie
Prognoza w zwężeniu kanału kręgowego zależy od wielu czynników, w tym samooceny stanu zdrowia pacjenta przed operacją, współchorobowości, parametrów elektrofizjologicznych oraz cech radiologicznych. Chociaż leczenie operacyjne poprawia stan około dwóch trzecich pacjentów, nadal istnieje znaczna grupa pacjentów, którzy nie odnoszą korzyści z operacji.
Nowe technologie, takie jak uczenie maszynowe, oferują obiecujące narzędzia do lepszego przewidywania wyników leczenia i personalizacji decyzji terapeutycznych. Badania w tym obszarze mogą przyczynić się do opracowania bardziej precyzyjnych wytycznych dotyczących praktyki klinicznej i poprawy opieki nad pacjentami z zwężeniem kanału kręgowego.3132
Bazując na wynikach tych badań, lekarze będą mogli lepiej informować pacjentów, z których niektórzy cierpią na więcej niż jedną chorobę, o spodziewanym przebiegu choroby i pomóc pacjentom i lekarzom w decydowaniu, którą terapię wybrać.33
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Materiały źródłowe
- #1 Comparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6303618/
Lumbar spinal stenosis is a common cause of low back and leg pain in the elderly and affects both physical activity and quality of life. […] The literature is not clear as to the outcome of surgery compared with non-surgical treatment, and the optimal time for surgery is not explicit. […] This observational study is designed to investigate the course of treatment, compare effectiveness of surgical and non-surgical management in patients with lumbar spinal stenosis and identify prognostic factors for outcome in the context of current clinical practice. […] The literature is not clear as to the outcome of surgery compared with non-surgical treatment, however, and the optimal timing for surgical decompression has not yet been established. […] Surgery has been reported as the most effective treatment for lumbar spinal stenosis when outcome is defined as reduced pain and disability and improved quality of life.
- #2https://link.springer.com/article/10.1007/s00586-012-2424-7
The natural course of lumbar spinal stenosis (LSS) fluctuates and is not necessarily progressive. The aim of this study was to explore the predictors of clinical outcome in patients with LSS that might eventually help to optimise the therapeutic choices. […] A group of 56 patients (27 men, 29 women, median age 55; range 31-72 years) with clinically symptomatic mild-to-moderate LSS were re-examined after a median period of 88 months and their clinical outcomes classified as satisfactory (34 patients, 60.7 % with stable or improved clinical status) or unsatisfactory (22 patients, 39.3 % for whom clinical status deteriorated). […] Unlike the demographical, clinical and imaging variables, certain electrophysiological parameters were significantly associated with unsatisfactory outcomes. […] Satisfactory outcomes were disclosed in about 61 % of the patients with mild-to-moderate LSS in a 7-year follow-up. Electrophysiological abnormalities, namely the presence of pluriradicular involvement and abnormalities of the soleus H-reflex, were predictive of deterioration of clinical status in these patients.
- #3https://link.springer.com/article/10.1007/s00586-012-2424-7
The natural course of lumbar spinal stenosis (LSS) fluctuates and is not necessarily progressive. The aim of this study was to explore the predictors of clinical outcome in patients with LSS that might eventually help to optimise the therapeutic choices. […] A group of 56 patients (27 men, 29 women, median age 55; range 31-72 years) with clinically symptomatic mild-to-moderate LSS were re-examined after a median period of 88 months and their clinical outcomes classified as satisfactory (34 patients, 60.7 % with stable or improved clinical status) or unsatisfactory (22 patients, 39.3 % for whom clinical status deteriorated). […] Unlike the demographical, clinical and imaging variables, certain electrophysiological parameters were significantly associated with unsatisfactory outcomes. […] Satisfactory outcomes were disclosed in about 61 % of the patients with mild-to-moderate LSS in a 7-year follow-up. Electrophysiological abnormalities, namely the presence of pluriradicular involvement and abnormalities of the soleus H-reflex, were predictive of deterioration of clinical status in these patients.
- #4 Spinal Stenosis: What It Is, Causes, Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/17499-spinal-stenosis
The prognosis (outlook) for spinal stenosis varies based on several factors, like: […] In most cases, the prognosis for spinal stenosis is good. Many people with spinal stenosis can live full and active lives with nonsurgical treatment. But its important to remember that spinal stenosis affects each person differently, so not every treatment works for everyone.
- #5 LumbSten: The lumbar spinal stenosis outcome study | BMC Musculoskeletal Disorders | Full Texthttps://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-254
Lumbar spinal stenosis is the most frequent reason for spinal surgery in elderly people. […] There is some evidence that surgery improves outcome in about two thirds of the patients. […] The long term success rates of surgery vary between 45% and 72%, depending on the measured clinical outcome assessed (pain, walking capacity, neurologic symptoms, working ability). […] The outcome of surgery depends on a number of different factors. […] A lower self rated preoperative health-status, comorbidity, depression and limited, preoperative walking ability are strong predictors of an unfavorable clinical outcome. […] Based on the results of the study we will learn about indicators predicting the future course of patients with lumbar spinal stenosis with and without surgical therapy. These results will support physicians in informing patients, some of them suffering from more than one illness, about the expected course of the illness and help patients and physicians in deciding which therapy to choose.
- #6 LumbSten: The lumbar spinal stenosis outcome study | BMC Musculoskeletal Disorders | Full Texthttps://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-254
Lumbar spinal stenosis is the most frequent reason for spinal surgery in elderly people. […] There is some evidence that surgery improves outcome in about two thirds of the patients. […] The long term success rates of surgery vary between 45% and 72%, depending on the measured clinical outcome assessed (pain, walking capacity, neurologic symptoms, working ability). […] The outcome of surgery depends on a number of different factors. […] A lower self rated preoperative health-status, comorbidity, depression and limited, preoperative walking ability are strong predictors of an unfavorable clinical outcome. […] Based on the results of the study we will learn about indicators predicting the future course of patients with lumbar spinal stenosis with and without surgical therapy. These results will support physicians in informing patients, some of them suffering from more than one illness, about the expected course of the illness and help patients and physicians in deciding which therapy to choose.
- #7 Predictors of surgical outcome in degenerative lumbar spinal stenosis – PubMedhttps://pubmed.ncbi.nlm.nih.gov/10562989/
Study design: A prospective, observational study. […] Objectives: To identify outcome predictors of surgery for degenerative lumbar spinal stenosis. […] More than 25% of surgical patients have a poor outcome, yet little is known about factors that predict the outcome of surgery. […] The most powerful preoperation predictor of greater walking capacity, milder symptoms, and greater satisfaction was the patient’s report of good or excellent health before surgery. […] Low cardiovascular comorbidity also predicted a favorable outcome. […] Patient’s assessments of their own health and comorbidity are the most cogent outcome predictors of surgery for spinal stenosis.
- #8 Comparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6303618/
A recent systematic literature review reported no differences in pain-related disability between surgery and non-surgical treatment at 3, 6 and 12 months, with only one of five studies reporting a difference in favour of surgery. […] Hence, it is relevant to investigate the outcome of non-surgical treatment and to identify prognostic factors that could help determine which patients are more likely to manage without surgical treatment, and which patients would benefit more from surgery. […] Multiple factors may be related to the outcome from lumbar spinal stenosis surgery including duration of symptoms, greater back pain relative to leg pain, smoking, previous spinal surgery, preoperative function, self-rated health, income, comorbidity and psychosocial factors. […] Symptomatic improvement is also seen in non-surgical treatment, but evidence is sparse for prognostic factors of outcome in non-surgical management and the aspects that guide allocation of treatment.
- #9 Comparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6303618/
Lumbar spinal stenosis is a common cause of low back and leg pain in the elderly and affects both physical activity and quality of life. […] The literature is not clear as to the outcome of surgery compared with non-surgical treatment, and the optimal time for surgery is not explicit. […] This observational study is designed to investigate the course of treatment, compare effectiveness of surgical and non-surgical management in patients with lumbar spinal stenosis and identify prognostic factors for outcome in the context of current clinical practice. […] The literature is not clear as to the outcome of surgery compared with non-surgical treatment, however, and the optimal timing for surgical decompression has not yet been established. […] Surgery has been reported as the most effective treatment for lumbar spinal stenosis when outcome is defined as reduced pain and disability and improved quality of life.
- #10 LumbSten: The lumbar spinal stenosis outcome study | BMC Musculoskeletal Disorders | Full Texthttps://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-254
Lumbar spinal stenosis is the most frequent reason for spinal surgery in elderly people. […] There is some evidence that surgery improves outcome in about two thirds of the patients. […] The long term success rates of surgery vary between 45% and 72%, depending on the measured clinical outcome assessed (pain, walking capacity, neurologic symptoms, working ability). […] The outcome of surgery depends on a number of different factors. […] A lower self rated preoperative health-status, comorbidity, depression and limited, preoperative walking ability are strong predictors of an unfavorable clinical outcome. […] Based on the results of the study we will learn about indicators predicting the future course of patients with lumbar spinal stenosis with and without surgical therapy. These results will support physicians in informing patients, some of them suffering from more than one illness, about the expected course of the illness and help patients and physicians in deciding which therapy to choose.
- #11 Predictors of surgical outcome in degenerative lumbar spinal stenosis – PubMedhttps://pubmed.ncbi.nlm.nih.gov/10562989/
Study design: A prospective, observational study. […] Objectives: To identify outcome predictors of surgery for degenerative lumbar spinal stenosis. […] More than 25% of surgical patients have a poor outcome, yet little is known about factors that predict the outcome of surgery. […] The most powerful preoperation predictor of greater walking capacity, milder symptoms, and greater satisfaction was the patient’s report of good or excellent health before surgery. […] Low cardiovascular comorbidity also predicted a favorable outcome. […] Patient’s assessments of their own health and comorbidity are the most cogent outcome predictors of surgery for spinal stenosis.
- #12 Predictors of surgical outcome in degenerative lumbar spinal stenosis – PubMedhttps://pubmed.ncbi.nlm.nih.gov/10562989/
Study design: A prospective, observational study. […] Objectives: To identify outcome predictors of surgery for degenerative lumbar spinal stenosis. […] More than 25% of surgical patients have a poor outcome, yet little is known about factors that predict the outcome of surgery. […] The most powerful preoperation predictor of greater walking capacity, milder symptoms, and greater satisfaction was the patient’s report of good or excellent health before surgery. […] Low cardiovascular comorbidity also predicted a favorable outcome. […] Patient’s assessments of their own health and comorbidity are the most cogent outcome predictors of surgery for spinal stenosis.
- #13 Predictors of surgical outcome in degenerative lumbar spinal stenosis – PubMedhttps://pubmed.ncbi.nlm.nih.gov/10562989/
Study design: A prospective, observational study. […] Objectives: To identify outcome predictors of surgery for degenerative lumbar spinal stenosis. […] More than 25% of surgical patients have a poor outcome, yet little is known about factors that predict the outcome of surgery. […] The most powerful preoperation predictor of greater walking capacity, milder symptoms, and greater satisfaction was the patient’s report of good or excellent health before surgery. […] Low cardiovascular comorbidity also predicted a favorable outcome. […] Patient’s assessments of their own health and comorbidity are the most cogent outcome predictors of surgery for spinal stenosis.
- #14 Comparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6303618/
A recent systematic literature review reported no differences in pain-related disability between surgery and non-surgical treatment at 3, 6 and 12 months, with only one of five studies reporting a difference in favour of surgery. […] Hence, it is relevant to investigate the outcome of non-surgical treatment and to identify prognostic factors that could help determine which patients are more likely to manage without surgical treatment, and which patients would benefit more from surgery. […] Multiple factors may be related to the outcome from lumbar spinal stenosis surgery including duration of symptoms, greater back pain relative to leg pain, smoking, previous spinal surgery, preoperative function, self-rated health, income, comorbidity and psychosocial factors. […] Symptomatic improvement is also seen in non-surgical treatment, but evidence is sparse for prognostic factors of outcome in non-surgical management and the aspects that guide allocation of treatment.
- #15https://link.springer.com/article/10.1007/s00586-012-2424-7
The natural course of lumbar spinal stenosis (LSS) fluctuates and is not necessarily progressive. The aim of this study was to explore the predictors of clinical outcome in patients with LSS that might eventually help to optimise the therapeutic choices. […] A group of 56 patients (27 men, 29 women, median age 55; range 31-72 years) with clinically symptomatic mild-to-moderate LSS were re-examined after a median period of 88 months and their clinical outcomes classified as satisfactory (34 patients, 60.7 % with stable or improved clinical status) or unsatisfactory (22 patients, 39.3 % for whom clinical status deteriorated). […] Unlike the demographical, clinical and imaging variables, certain electrophysiological parameters were significantly associated with unsatisfactory outcomes. […] Satisfactory outcomes were disclosed in about 61 % of the patients with mild-to-moderate LSS in a 7-year follow-up. Electrophysiological abnormalities, namely the presence of pluriradicular involvement and abnormalities of the soleus H-reflex, were predictive of deterioration of clinical status in these patients.
- #16 Outcomes of Surgery in Patients with Lumbar Spinal Canal Stenosis: Comparison of Three Types of Stenosis on MRI | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158041
The aim of the study was to compare outcome of surgery in patients with lumbar canal stenosis (LCS) based on magnetic resonance imaging (MRI) morphology. […] The findings suggest that the type of stenosis based on magnetic resonance imaging morphology is not indicative of surgical outcome among lumbar canal stenosis patients who undergo surgery at 1-year follow-up. […] Our results showed that no differences in surgical outcomes were observed between the magnetic resonance imaging morphology types in patients with lumbar canal stenosis at 1-year follow-up. Hence, the type of stenosis may not be a pre-operative predictor of surgical success. […] A mean score of 2.5 or lower for SSS Q13Q18 was considered as successful outcome. Based on type of stenosis surgery successful outcomes are shown in Table 2. It was found that 87.5% (n = 84) of patients had surgical successful outcome at 1-year follow-up. No significant differences between groups were found, based on type of stenosis. […] Further analysis, comprised of a larger, longitudinal sample, would contribute to outcomes research, and assist with future practice guideline development.
- #17 Outcomes of Surgery in Patients with Lumbar Spinal Canal Stenosis: Comparison of Three Types of Stenosis on MRI | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158041
The aim of the study was to compare outcome of surgery in patients with lumbar canal stenosis (LCS) based on magnetic resonance imaging (MRI) morphology. […] The findings suggest that the type of stenosis based on magnetic resonance imaging morphology is not indicative of surgical outcome among lumbar canal stenosis patients who undergo surgery at 1-year follow-up. […] Our results showed that no differences in surgical outcomes were observed between the magnetic resonance imaging morphology types in patients with lumbar canal stenosis at 1-year follow-up. Hence, the type of stenosis may not be a pre-operative predictor of surgical success. […] A mean score of 2.5 or lower for SSS Q13Q18 was considered as successful outcome. Based on type of stenosis surgery successful outcomes are shown in Table 2. It was found that 87.5% (n = 84) of patients had surgical successful outcome at 1-year follow-up. No significant differences between groups were found, based on type of stenosis. […] Further analysis, comprised of a larger, longitudinal sample, would contribute to outcomes research, and assist with future practice guideline development.
- #18https://link.springer.com/article/10.1007/s00701-023-05693-5
We aim to investigate associations between preoperative radiological findings of lumbar foraminal stenosis with clinical outcomes after posterior microsurgical decompression in patients with predominantly central lumbar spinal stenosis (LSS). […] A significant association between severe foraminal stenosis and less chance of reaching the target of 30% improvement in the ODI score after surgery was detected: OR 0.22 (95% CI 0.06, 0.83), p=0.03. […] In patients operated with posterior microsurgical decompression for LSS, a preoperative severe lumbar foraminal stenosis was associated with higher proportion of patients with less than 30% improvement in ODI. […] The main observation in this study was the association between severe foraminal stenosis of the lumbar foramina and significantly reduced chance of reaching a 30% improvement in the ODI score after microsurgical decompression for lumbar spinal stenosis. […] The presence of severe foraminal stenosis as a part of the LSS entity at baseline suggests less improvement in ODI and NRS back pain after posterior microsurgical decompression.
- #19https://link.springer.com/article/10.1007/s00701-023-05693-5
We aim to investigate associations between preoperative radiological findings of lumbar foraminal stenosis with clinical outcomes after posterior microsurgical decompression in patients with predominantly central lumbar spinal stenosis (LSS). […] A significant association between severe foraminal stenosis and less chance of reaching the target of 30% improvement in the ODI score after surgery was detected: OR 0.22 (95% CI 0.06, 0.83), p=0.03. […] In patients operated with posterior microsurgical decompression for LSS, a preoperative severe lumbar foraminal stenosis was associated with higher proportion of patients with less than 30% improvement in ODI. […] The main observation in this study was the association between severe foraminal stenosis of the lumbar foramina and significantly reduced chance of reaching a 30% improvement in the ODI score after microsurgical decompression for lumbar spinal stenosis. […] The presence of severe foraminal stenosis as a part of the LSS entity at baseline suggests less improvement in ODI and NRS back pain after posterior microsurgical decompression.
- #20https://link.springer.com/article/10.1007/s00586-012-2424-7
The natural course of lumbar spinal stenosis (LSS) fluctuates and is not necessarily progressive. The aim of this study was to explore the predictors of clinical outcome in patients with LSS that might eventually help to optimise the therapeutic choices. […] A group of 56 patients (27 men, 29 women, median age 55; range 31-72 years) with clinically symptomatic mild-to-moderate LSS were re-examined after a median period of 88 months and their clinical outcomes classified as satisfactory (34 patients, 60.7 % with stable or improved clinical status) or unsatisfactory (22 patients, 39.3 % for whom clinical status deteriorated). […] Unlike the demographical, clinical and imaging variables, certain electrophysiological parameters were significantly associated with unsatisfactory outcomes. […] Satisfactory outcomes were disclosed in about 61 % of the patients with mild-to-moderate LSS in a 7-year follow-up. Electrophysiological abnormalities, namely the presence of pluriradicular involvement and abnormalities of the soleus H-reflex, were predictive of deterioration of clinical status in these patients.
- #21https://link.springer.com/article/10.1007/s00586-012-2424-7
The natural course of lumbar spinal stenosis (LSS) fluctuates and is not necessarily progressive. The aim of this study was to explore the predictors of clinical outcome in patients with LSS that might eventually help to optimise the therapeutic choices. […] A group of 56 patients (27 men, 29 women, median age 55; range 31-72 years) with clinically symptomatic mild-to-moderate LSS were re-examined after a median period of 88 months and their clinical outcomes classified as satisfactory (34 patients, 60.7 % with stable or improved clinical status) or unsatisfactory (22 patients, 39.3 % for whom clinical status deteriorated). […] Unlike the demographical, clinical and imaging variables, certain electrophysiological parameters were significantly associated with unsatisfactory outcomes. […] Satisfactory outcomes were disclosed in about 61 % of the patients with mild-to-moderate LSS in a 7-year follow-up. Electrophysiological abnormalities, namely the presence of pluriradicular involvement and abnormalities of the soleus H-reflex, were predictive of deterioration of clinical status in these patients.
- #22 Comparison of clinical outcome of lumbar spinal stenosis surgery in patients with and without osteoporosis: a prospective cohort study | Journal of Orthopaedic Surgery and Research | Full Texthttps://josr-online.biomedcentral.com/articles/10.1186/s13018-023-03935-x
This study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. […] Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability for all patients, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.
- #23 Comparison of clinical outcome of lumbar spinal stenosis surgery in patients with and without osteoporosis: a prospective cohort study | Journal of Orthopaedic Surgery and Research | Full Texthttps://josr-online.biomedcentral.com/articles/10.1186/s13018-023-03935-x
This study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. […] Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability for all patients, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.
- #24 Machine learningâbased preoperative predictive analytics for lumbar spinal stenosis in: Neurosurgical Focus Volume 46 Issue 5 (2019) Journalshttps://thejns.org/focus/view/journals/neurosurg-focus/46/5/article-pE5.xml
Patient-reported outcome measures (PROMs) following decompression surgery for lumbar spinal stenosis (LSS) demonstrate considerable heterogeneity. Individualized prediction tools can provide valuable insights for shared decision-making. […] Preoperative prediction of a range of clinically relevant endpoints in decompression surgery for LSS using ML is feasible, and may enable enhanced informed patient consent and personalized shared decision-making. Access to individualized preoperative predictive analytics for outcome and treatment risks may represent a further step in the evolution of surgical care for patients with LSS. […] The hope for these new techniques is that they will enable surgeons to accurately predict adverse events and outcomes that were previously near unpredictable, such as reoperations or a positive outcome, in order to identify those patients who will benefit most from surgical care.
- #25 Machine learningâbased preoperative predictive analytics for lumbar spinal stenosis in: Neurosurgical Focus Volume 46 Issue 5 (2019) Journalshttps://thejns.org/focus/view/journals/neurosurg-focus/46/5/article-pE5.xml
Patient-reported outcome measures (PROMs) following decompression surgery for lumbar spinal stenosis (LSS) demonstrate considerable heterogeneity. Individualized prediction tools can provide valuable insights for shared decision-making. […] Preoperative prediction of a range of clinically relevant endpoints in decompression surgery for LSS using ML is feasible, and may enable enhanced informed patient consent and personalized shared decision-making. Access to individualized preoperative predictive analytics for outcome and treatment risks may represent a further step in the evolution of surgical care for patients with LSS. […] The hope for these new techniques is that they will enable surgeons to accurately predict adverse events and outcomes that were previously near unpredictable, such as reoperations or a positive outcome, in order to identify those patients who will benefit most from surgical care.
- #26 Machine learningâbased preoperative predictive analytics for lumbar spinal stenosis in: Neurosurgical Focus Volume 46 Issue 5 (2019) Journalshttps://thejns.org/focus/view/journals/neurosurg-focus/46/5/article-pE5.xml
The developed ML-based model enabled prediction of extended hospital stay with an accuracy of 77% and AUC of 0.58. […] Overall and index-level reoperations were predicted with 69% and 63% accuracy, respectively, and with AUCs of 0.66 and 0.61. […] The models were able to predict the endpoints of interest with employable performance at internal validation from easily accessible preoperative data. […] The variability in indications, choice of surgical technique, and outcomes is notorious in elective spine surgery for LSS. […] Such prediction tools, whether based on ML or on more traditional statistical modeling methods, also have distinct advantages other than potentially increased precision. […] In this way, they may enable enhanced and more individualized shared decision-making. […] Our study shows that this is feasible.
- #27 Machine learningâbased preoperative predictive analytics for lumbar spinal stenosis in: Neurosurgical Focus Volume 46 Issue 5 (2019) Journalshttps://thejns.org/focus/view/journals/neurosurg-focus/46/5/article-pE5.xml
The developed ML-based model enabled prediction of extended hospital stay with an accuracy of 77% and AUC of 0.58. […] Overall and index-level reoperations were predicted with 69% and 63% accuracy, respectively, and with AUCs of 0.66 and 0.61. […] The models were able to predict the endpoints of interest with employable performance at internal validation from easily accessible preoperative data. […] The variability in indications, choice of surgical technique, and outcomes is notorious in elective spine surgery for LSS. […] Such prediction tools, whether based on ML or on more traditional statistical modeling methods, also have distinct advantages other than potentially increased precision. […] In this way, they may enable enhanced and more individualized shared decision-making. […] Our study shows that this is feasible.
- #28 Machine learningâbased preoperative predictive analytics for lumbar spinal stenosis in: Neurosurgical Focus Volume 46 Issue 5 (2019) Journalshttps://thejns.org/focus/view/journals/neurosurg-focus/46/5/article-pE5.xml
The developed ML-based model enabled prediction of extended hospital stay with an accuracy of 77% and AUC of 0.58. […] Overall and index-level reoperations were predicted with 69% and 63% accuracy, respectively, and with AUCs of 0.66 and 0.61. […] The models were able to predict the endpoints of interest with employable performance at internal validation from easily accessible preoperative data. […] The variability in indications, choice of surgical technique, and outcomes is notorious in elective spine surgery for LSS. […] Such prediction tools, whether based on ML or on more traditional statistical modeling methods, also have distinct advantages other than potentially increased precision. […] In this way, they may enable enhanced and more individualized shared decision-making. […] Our study shows that this is feasible.
- #29 Machine Learning Predicts Decompression Levels for Lumbar Spinal Stenosis Using Canal Radiomic Features from Computed Tomography Myelographyhttps://www.mdpi.com/2075-4418/14/1/53
ML successfully extracted valuable and interpretable radiomic features from the spinal canal using CTM images and accurately predicted decompression levels in LSS patients. […] The EmbeddingLSVC_SVM classifier has the potential to assist in surgical decision-making processes in clinical practice, as it showed high discrimination, favorable calibration, and advantageous utility in selecting decompression levels in LSS patients using canal radiomic features from CTM. […] Accurately predicting decompression levels before surgery would undoubtedly benefit surgical decision making for LSS patients. […] In outcome predictions for LSS, researchers have also reported several ML studies such as patient-reported outcome measures, clinical outcome predictions, patient-specific outcomes, and surgical candidacy prediction.
- #30 Machine Learning Predicts Decompression Levels for Lumbar Spinal Stenosis Using Canal Radiomic Features from Computed Tomography Myelographyhttps://www.mdpi.com/2075-4418/14/1/53
ML successfully extracted valuable and interpretable radiomic features from the spinal canal using CTM images and accurately predicted decompression levels in LSS patients. […] The EmbeddingLSVC_SVM classifier has the potential to assist in surgical decision-making processes in clinical practice, as it showed high discrimination, favorable calibration, and advantageous utility in selecting decompression levels in LSS patients using canal radiomic features from CTM. […] Accurately predicting decompression levels before surgery would undoubtedly benefit surgical decision making for LSS patients. […] In outcome predictions for LSS, researchers have also reported several ML studies such as patient-reported outcome measures, clinical outcome predictions, patient-specific outcomes, and surgical candidacy prediction.
- #31 Outcomes of Surgery in Patients with Lumbar Spinal Canal Stenosis: Comparison of Three Types of Stenosis on MRI | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158041
The aim of the study was to compare outcome of surgery in patients with lumbar canal stenosis (LCS) based on magnetic resonance imaging (MRI) morphology. […] The findings suggest that the type of stenosis based on magnetic resonance imaging morphology is not indicative of surgical outcome among lumbar canal stenosis patients who undergo surgery at 1-year follow-up. […] Our results showed that no differences in surgical outcomes were observed between the magnetic resonance imaging morphology types in patients with lumbar canal stenosis at 1-year follow-up. Hence, the type of stenosis may not be a pre-operative predictor of surgical success. […] A mean score of 2.5 or lower for SSS Q13Q18 was considered as successful outcome. Based on type of stenosis surgery successful outcomes are shown in Table 2. It was found that 87.5% (n = 84) of patients had surgical successful outcome at 1-year follow-up. No significant differences between groups were found, based on type of stenosis. […] Further analysis, comprised of a larger, longitudinal sample, would contribute to outcomes research, and assist with future practice guideline development.
- #32 Machine learningâbased preoperative predictive analytics for lumbar spinal stenosis in: Neurosurgical Focus Volume 46 Issue 5 (2019) Journalshttps://thejns.org/focus/view/journals/neurosurg-focus/46/5/article-pE5.xml
Patient-reported outcome measures (PROMs) following decompression surgery for lumbar spinal stenosis (LSS) demonstrate considerable heterogeneity. Individualized prediction tools can provide valuable insights for shared decision-making. […] Preoperative prediction of a range of clinically relevant endpoints in decompression surgery for LSS using ML is feasible, and may enable enhanced informed patient consent and personalized shared decision-making. Access to individualized preoperative predictive analytics for outcome and treatment risks may represent a further step in the evolution of surgical care for patients with LSS. […] The hope for these new techniques is that they will enable surgeons to accurately predict adverse events and outcomes that were previously near unpredictable, such as reoperations or a positive outcome, in order to identify those patients who will benefit most from surgical care.
- #33 LumbSten: The lumbar spinal stenosis outcome study | BMC Musculoskeletal Disorders | Full Texthttps://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-254
Lumbar spinal stenosis is the most frequent reason for spinal surgery in elderly people. […] There is some evidence that surgery improves outcome in about two thirds of the patients. […] The long term success rates of surgery vary between 45% and 72%, depending on the measured clinical outcome assessed (pain, walking capacity, neurologic symptoms, working ability). […] The outcome of surgery depends on a number of different factors. […] A lower self rated preoperative health-status, comorbidity, depression and limited, preoperative walking ability are strong predictors of an unfavorable clinical outcome. […] Based on the results of the study we will learn about indicators predicting the future course of patients with lumbar spinal stenosis with and without surgical therapy. These results will support physicians in informing patients, some of them suffering from more than one illness, about the expected course of the illness and help patients and physicians in deciding which therapy to choose.