title: Comparison of Effects of Nonoperative Treatment and Decompression Surgery on Risk of Patients with Lumbar Spinal Stenosis Falling: Evaluation with Functional Mobility Tests.
abstract: BACKGROUND
  Falls are a major factor contributing to fragility fractures. Patients with lumbar spinal stenosis have an increased risk of falling. We are aware of no prior report demonstrating the effect of medical treatment and decompression surgery on the risk of patients with lumbar spinal stenosis falling.
  
  
  METHODS
  From June to November 2011, seventy-six patients were enrolled into the surgery group and fifty patients, into the nonoperative group. Four functional mobility tests, including the Alternate-Step test, Six-Meter Walk test, Sit-to-Stand test, and timed "Up & Go" test, were used to evaluate the risk of falling. The Oswestry Disability Index (ODI) and the EuroQoL-5D (EQ-5D) visual analog scale (VAS) were utilized to assess clinical improvement.
  
  
  RESULTS
  The mean age was 62.4 years in the surgery group and 64.6 years in the nonoperative group. The results of the Alternate-Step test significantly improved during the follow-up period in the surgery group (p = 0.001). However, the results of the Alternate-Step test significantly worsened during the follow-up period in the nonoperative group (p = 0.001). Comparison between the two groups showed more significant improvement in the surgery group, especially for the Six-Meter Walk test at one year postoperatively (p = 0.042) and for the timed "Up & Go" test at three months and one year (p = 0.046 and 0.000). However, the ODI and EQ-5D VAS scores improved in both groups. In a linear mixed model, age, surgery, and the presence of an osteoporotic compression fracture significantly affected the test results related to the risk of falling (p < 0.05).
  
  
  CONCLUSIONS
  The surgery group showed a greater decrease in the risk of falling than those in the nonoperative group. Improved physical performance, including walking and balancing, after decompression lumbar spinal surgery reduces the future risk of falling.
  
  
  METHODS
  Therapeutic Level II. Retrospective analysis of prospectively collected data. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. E-mail address for B.H. Lee: 144667@daum.net. E-mail address for S. Lim: aastudent@yuhs.ac. E-mail address for S.H. Moon: shmoon@yuhs.ac. E-mail address for J.-O. Park: jopark@yuhs.ac. E-mail address for H.-S. Kim: haksunkim@yuhs.ac. E-mail address for H.-M. Lee: hwanlee@yuhs.ac.
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Hallym University College of Medicine, 896 Pyungchon-dong, Manan-Gu, Kyung-ki, 431-796, South Korea. E-mail address for T.-H. Kim: paragon78@gmail.com. E-mail address for M.-S. Park: amhangpark@gmail.com.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Hallym University College of Medicine, 896 Pyungchon-dong, Manan-Gu, Kyung-ki, 431-796, South Korea. E-mail address for T.-H. Kim: paragon78@gmail.com. E-mail address for M.-S. Park: amhangpark@gmail.com.
authors.forename: Moon-Soo
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. E-mail address for B.H. Lee: 144667@daum.net. E-mail address for S. Lim: aastudent@yuhs.ac. E-mail address for S.H. Moon: shmoon@yuhs.ac. E-mail address for J.-O. Park: jopark@yuhs.ac. E-mail address for H.-S. Kim: haksunkim@yuhs.ac. E-mail address for H.-M. Lee: hwanlee@yuhs.ac.
authors.forename: Suhan
authors.initials: S
authors.lastname: Lim
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. E-mail address for B.H. Lee: 144667@daum.net. E-mail address for S. Lim: aastudent@yuhs.ac. E-mail address for S.H. Moon: shmoon@yuhs.ac. E-mail address for J.-O. Park: jopark@yuhs.ac. E-mail address for H.-S. Kim: haksunkim@yuhs.ac. E-mail address for H.-M. Lee: hwanlee@yuhs.ac.
authors.forename: Jin-Oh
authors.initials: JO
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. E-mail address for B.H. Lee: 144667@daum.net. E-mail address for S. Lim: aastudent@yuhs.ac. E-mail address for S.H. Moon: shmoon@yuhs.ac. E-mail address for J.-O. Park: jopark@yuhs.ac. E-mail address for H.-S. Kim: haksunkim@yuhs.ac. E-mail address for H.-M. Lee: hwanlee@yuhs.ac.
authors.forename: Hak-Sun
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Bundang Seoul National University Hospital, Kumi-ro, 173-82, Bundang, Kyung-gi, 463-707, South Korea. E-mail address for H.-J. Kim: oshjkim@gmail.com.
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. E-mail address for B.H. Lee: 144667@daum.net. E-mail address for S. Lim: aastudent@yuhs.ac. E-mail address for S.H. Moon: shmoon@yuhs.ac. E-mail address for J.-O. Park: jopark@yuhs.ac. E-mail address for H.-S. Kim: haksunkim@yuhs.ac. E-mail address for H.-M. Lee: hwanlee@yuhs.ac.
authors.forename: Hwan-Mo
authors.initials: HM
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. E-mail address for B.H. Lee: 144667@daum.net. E-mail address for S. Lim: aastudent@yuhs.ac. E-mail address for S.H. Moon: shmoon@yuhs.ac. E-mail address for J.-O. Park: jopark@yuhs.ac. E-mail address for H.-S. Kim: haksunkim@yuhs.ac. E-mail address for H.-M. Lee: hwanlee@yuhs.ac.
authors.forename: Seong-Hwan
authors.initials: SH
authors.lastname: Moon
mesh_terms: D000058:Accidental Falls; D000368:Aged; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012306:Risk; D013130:Spinal Stenosis / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome