title: The Risk of Getting Worse: Predictors of Deterioration After Decompressive Surgery for Lumbar Spinal Stenosis: A Multicenter Observational Study.
abstract: OBJECTIVE
  To investigate the frequency and predictors of deterioration after decompressive surgery for single and 2-level lumbar spinal stenosis.
  
  
  METHODS
  Prospectively collected data were retrieved from the Norwegian Registry for Spine Surgery. Clinically significant deterioration was defined as an 8-point increase in Oswestry disability index (ODI) between baseline and 12 months' follow-up.
  
  
  RESULTS
  There were 2181 patients enrolled in the study. Of 1735 patients with complete 12 months follow-up, 151 (8.7%) patients reported deterioration. The following variables were significantly associated with deterioration at 12 months' follow-up; decreasing age (odds ratio [OR] 1.02, 95% confidence interval [95% CI] 1.00-1.04, P = 0.046), tobacco smoking (OR 2.10, 95% CI 1.42-3.22, P = 0.000), American Society of Anesthesiologists grade ≥3 (OR 1.80, 95% CI 1.07-2.94, P = 0.025), decreasing preoperative ODI (OR 1.05, 95% CI 1.02-1.07, P = 0.000), previous surgery at the same level (OR 2.00, 95% CI 1.18-3.27, P = 0.009), and previous surgery at other lumbar levels (OR 2.10, 95% CI 1.19-3.53, P = 0.009).
  
  
  CONCLUSIONS
  Overall risk of clinically significant deterioration in patient-reported pain and disability after decompressive surgery for lumbar spinal stenosis is approximately 9%. Predictors for deterioration are decreasing age, current tobacco smoking, American Society of Anesthesiologists grade ≥3, decreasing preoperative ODI, and previous surgery at same or different lumbar level. We suggest that these predictors should be emphasized and discussed with the patients before surgery.
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Electronic address: ulfskule@gmail.com.
authors.forename: Ulf S
authors.initials: US
authors.lastname: Nerland
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; National Centre for Ultrasound and Image-Guided Therapy, Trondheim, Norway; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Asgeir S
authors.initials: AS
authors.lastname: Jakola
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Charalampis
authors.initials: C
authors.lastname: Giannadakis
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; National Centre for Ultrasound and Image-Guided Therapy, Trondheim, Norway.
authors.forename: Ole
authors.initials: O
authors.lastname: Solheim
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; National Advisory Unit on Spinal Surgery Center for Spinal Disorders, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Clemens
authors.initials: C
authors.lastname: Weber
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; National Advisory Unit on Spinal Surgery Center for Spinal Disorders, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Øystein P
authors.initials: ØP
authors.lastname: Nygaard
authors.affiliation: Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway; The Norwegian National Registry for Spine Surgery, Center for Clinical Documentation and Evaluation (SKDE), North Norway Regional Health Authority, Tromsø, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Solberg
authors.affiliation: Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Norwegian Centre of Competence in Deep Brain Stimulation for Movement Disorders, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Sasha
authors.initials: S
authors.lastname: Gulati
mesh_terms: D000368:Aged; D000375:Aging; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000009:adverse effects*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation / Q000009:adverse effects; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Quality of life; Spinal stenosis; Spondylosis