title: Impact of pain on function and health related quality of life in lumbar spinal stenosis. A register study of 14,821 patients.
abstract: METHODS
  Descriptive register study.
  
  
  OBJECTIVE
  To describe preoperative levels of leg and back pain in patients operated for lumbar spinal stenosis, and to obtain information on how 3 different pain constellations (back pain < leg pain, back pain > leg pain, back pain = leg pain) correlate to health related quality of life (HRQoL) and function in different morphological types of stenosis.
  
  
  BACKGROUND
  Degenerative lumbar spinal stenosis is considered a poorly defined clinical syndrome and knowledge of what uniquely characterizes the different morphological types of stenosis is lacking.
  
  
  METHODS
  Using the Swedish Spine Register, we studied (1) the pain characteristics of patients with central spinal stenosis (CSS), lateral recess stenosis, and spinal stenosis with spondylolisthesis (2) how HRQoL and function correlate to leg and back pain.
  
  
  RESULTS
  Grading leg pain higher than back pain was the most common pain constellation (49%) followed by grading back pain more than leg pain (39%). Twelve percent had the same intensity of leg and back pain. The type of stenosis grading the highest burden of back pain was spinal stenosis with spondylolisthesis (ratio = 0.93; [95% confidence interval, CI] = 0.92-0.95), followed by central spinal stenosis (ratio = 0.88; [95% CI] = 0.88-0.89). Lateral recess stenosis had the lowest burden of back pain (ratio = 0.85; [95% CI] = 0.83-0.87). The lowest HRQoL and function was found in spinal stenosis with spondylolisthesis (back pain = leg pain group) where 55% ([95% CI] = 50-59) of patients could not walk more than 100 m. Patients with lateral recess stenosis had better self-estimated walking distance.
  
  
  CONCLUSIONS
  Back pain is generally experienced to a high extent by patients scheduled for spinal stenosis surgery. HRQoL and function are low preoperatively irrespective of whether back or leg pain is predominant. In this large patient material patients who grade their back and leg pain as likeworthy have significantly lower values for HRQoL and function compared to patients reporting predominant leg or back pain but the difference is not clinically relevant.
authors.affiliation: Department of Orthopedics, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden. freyr_gauti.sigmundsson@med.lu.se
authors.forename: Freyr Gauti
authors.initials: FG
authors.lastname: Sigmundsson
authors.forename: Bo
authors.initials: B
authors.lastname: Jönsson
authors.forename: Björn
authors.initials: B
authors.lastname: Strömqvist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement; D057234:Preoperative Period; D011788:Quality of Life; D012042:Registries / Q000706:statistics & numerical data; D013130:Spinal Stenosis / Q000150:complications / Q000503:physiopathology*; D013168:Spondylolisthesis / Q000150:complications / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013548:Sweden