title: Preoperative predictors for good postoperative satisfaction and functional outcome in lumbar spinal stenosis surgery--a prospective observational study with a two-year follow-up.
abstract: OBJECTIVE
  Lumbar spinal stenosis (LSS) is the most frequent indication for back surgery in adults aged over 65 years, but about one-third of operated patients have less than good/excellent results from the operation. Awareness of outcome predictors and their predictive values may help clinicians in their assessment of the prognosis of patients when considering surgical treatment. Our aim was to study the preoperative predictors in LSS for a good postoperative outcome (satisfaction with surgery and functional improvement) with a two-year follow-up.
  
  
  METHODS
  LSS patients (n = 102) completed a questionnaire preoperatively and on two-year follow-up. Preoperative patient-related predictors, self-rated health, comorbidities and preoperative treatment were assessed. Satisfaction with the surgical outcome was assessed with a seven-category scale; satisfaction was determined to be good if the patient response was "condition has considerably improved" or "totally cured". Other responses ("condition has slightly improved" or worse) represented poorer satisfaction. A good functional outcome was determined as >30% relative improvement compared to the presurgery score in the Oswestry Disability Index (ODI).
  
  
  RESULTS
  The predictors for good satisfaction were age < 75 years at operation (OR 4.03; 95% CI 1.35-12.02; p = 0.012) and no previous lumbar operation (OR 3.65; 95% CI 1.13-11.79; p = 0.031). Predictors for a good improvement in the ODI score were regular preoperative analgesic use < 12 months (OR 3.40; 95% CI 1.21-9.53; p = 0.020), non-smoking (OR 3.47; 95% CI 1.09-11.03; p = 0.035) and good (above average) self-rated health (OR 3.27; 95% CI 1.06-10.12; p = 0.039).
  
  
  CONCLUSIONS
  In LSS, regular analgesic treatment preoperatively for 12 months or less, self-rated health above average and non-smoking predicted a good postoperative functional improvement. An age under 75 years and no previous lumbar operation predicted good post-operative satisfaction with the surgery.
authors.affiliation: Kyyhkylä Rehabilitation Center and Hospital, Mikkeli, Finland. timo.aalto@kyyhkyla.fi
authors.forename: T
authors.initials: T
authors.lastname: Aalto
authors.forename: S
authors.initials: S
authors.lastname: Sinikallio
authors.forename: H
authors.initials: H
authors.lastname: Kröger
authors.forename: H
authors.initials: H
authors.lastname: Viinamäki
authors.forename: A
authors.initials: A
authors.lastname: Herno
authors.forename: V
authors.initials: V
authors.lastname: Leinonen
authors.forename: V
authors.initials: V
authors.lastname: Turunen
authors.forename: S
authors.initials: S
authors.lastname: Savolainen
authors.forename: O
authors.initials: O
authors.lastname: Airaksinen
mesh_terms: D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D017586:Diskectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D057234:Preoperative Period; D011446:Prospective Studies; D020127:Recovery of Function; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome