Characterising patients undergoing surgery for lumbar spinal stenosis in the UK: what does the British spinal registry tell us?

Introduction 

Lumbar spinal stenosis (LSS) is the most common reason for people over 65 to undergo surgery, affecting ~10% of the community-dwelling population. Surgery for lumbar spinal stenosis has a variable outcome. We estimated the association between pre-operative patient demographics, surgical variables and patient-reported outcome measures (PROMs) with a clinically important change (30% change from baseline) in physical function at 6-months in a large, national registry database. 

Methods 

We used data from the British Spinal Registry (2013-2023). Anonymised data included demographics, PROMs (Oswestry Disability Index (ODI); back and leg pain on the visual analogue scale (VAS)) at 6-weeks and 6-months, surgical approach, surgery duration and intra-operative blood loss. We used descriptive and multivariate analyses. 

Results

2667 patients provided 6-month follow-up data on the ODI. They were on average 68.8 years of age (SD 11.5 years), male (n=1364/2667, 51%), and from higher socioeconomic areas (mean Index of Multiple Deprivation rank 83.7, SD 40.2). Prior to surgery, most patients had severe disability (mean ODI 46.9, SD 17.3), moderate leg (VAS mean 6.8, SD 2.5) and back pain (VAS mean 6.1, SD 2.5). Only 25% of the included sample (539/2119) achieved a clinically important improvement in ODI. Baseline back pain severity (OR 0.9; 95% CI 0.9, 1.0) reduced the odds; while more severe leg pain (OR 1.1; 95% CI 1.1, 1.2), baseline severe ODI (OR 4.3; 95% CI 3.3, 5.7) and male gender (OR 1.3; 95% CI 1.0, 1.6) increased the odds of achieving clinical change. 

Conclusions 

Patients undergoing surgery in the UK are severely disabled by symptoms prior to surgery. The available data suggests a substantial proportion of patients do not achieve a clinically important change by 6 months.