title: The role of stenosis ratio as a predictor of surgical satisfaction in patients with lumbar spinal canal stenosis: a receiver-operator characteristic (ROC) curve analysis.
abstract: BACKGROUND
  The aim of this study was to elucidate independent factors that predict surgical satisfaction in lumbar spinal canal stenosis (LSCS) patients.
  
  
  METHODS
  Patients who underwent surgery were grouped based on the age, gender, duration of symptoms, walking distance, Neurogenic Claudication Outcome Score (NCOS) and the stenosis ratio (SR) described by Lurencin. We recorded on 2-year patient satisfaction using standardized measure. The optimal cut-off points in SR, NCOS and walking distance for predicting surgical satisfaction were estimated from sensitivity and specificity calculations and receiver operator characteristic (ROC) curves.
  
  
  RESULTS
  One hundred fifty consecutive patients (51 male, 99 female, mean age 62.4±10.9 years) were followed up for 34±13 months (range 24-49). One, two, three and four level stenosis was observed in 10.7%, 39.3%, 36.0 % and 14.0% of patients, respectively. Post-surgical satisfaction was 78.5% at the 2 years follow up. In ROC curve analysis, the asymptotic significance is less than 0.05 in SR and the optimal cut-off value of SR to predict worsening surgical satisfaction was measured as more than 0.52, with 85.4% sensitivity and 77.4% specificity (AUC 0.798, 95% CI 0.73-0.90; P<0.01).
  
  
  CONCLUSIONS
  The present study suggests that the SR, with a cut-off set a 0.52 cross-sectional area, may be superior to walking distance and NCOS in patients with degenerative lumbar stenosis considered for surgical treatment. Using a ROC curve analysis, a radiological feature, the SR, demonstrated superiority in predicting patient satisfaction, compared to functional and clinical characteristics such as walking distance and NCOS.
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran - parisa.azimi@gmail.com.
authors.forename: Hassanreza R
authors.initials: HR
authors.lastname: Mohammadi
authors.forename: Parisa
authors.initials: P
authors.lastname: Azimi
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Sohrab
authors.initials: S
authors.lastname: Shahzadi
authors.forename: Shirzad
authors.initials: S
authors.lastname: Azhari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000601:surgery*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010549:Personal Satisfaction; D013115:Spinal Canal / Q000601:surgery*; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult