Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain.
METHODS
Longitudinal masked, double-controlled cohort study.


OBJECTIVE
To determine prognosis and predictors of function and pain in persons with spinal stenosis.


BACKGROUND
The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied.


METHODS
Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months.


RESULTS
Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain.


CONCLUSIONS
Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.
Haig
Andrew J
AJ
Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, USA. andyhaig@umich.du
Tong
Henry C
HC
Yamakawa
Karen S J
KS
Parres
Christopher
C
Quint
Douglas J
DJ
Chiodo
Anthony
A
Miner
Jennifer A
JA
Phalke
Vaishali C
VC
Hoff
Julian T
JT
Geisser
Michael E
ME
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D008159:Lumbar Vertebrae / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*