
Outcomes after Spinal Stenosis Surgery by Type of Surgery among Adults Age 60 Years and Older
Background: Mobility disability due to spinal stenosis is common in the senior population. We assessed the recovery timeline and compared outcomes among seniors undergoing spinal stenosis surgery by type of surgery.
Methods: We investigated 451 patients (77.4 ± 10.9 years, 58% women) of a consecutive cohort prior to spinal stenosis surgery and at 3 or 6-month and at 12-month follow-up. At each visit, pain, neurological dysfunction, and disability were assessed using the North American Spine Society questionnaire. Repeatedmeasures analysis compared outcomes by type of surgery adjusting for baseline symptoms, gender, age, comorbidities, center, and year of surgery.
Results: Most improvement occurred within the first 3 to 6 months with little or no improvement up to 12 months. Over 12 months and in adjusted models, patients receiving one-segment versus multi-segment decompression experienced greater reduction of pain (-46.0% vs. -41.0%; p = 0.05), neurological dysfunction (-36.4% vs. -26.1%; p < 0.001), and disability (-30.5% vs.-26.7%; p = 0.06). Moreover, reduction in pain and neurological function did not differ with or without additional stabilization and extend of decompression. However, patients who received one-segment (-26.7%) or multi-segment (-27.5%) stabilization experienced significantly less reduction in disability after surgery compared with those who were not stabilized (-31.6%; p < 0.05).
Conclusions: Among seniors undergoing spinal stenosis surgery, recovery was largely complete by 3 to 6 months after surgery, and differed little by type of surgery independent of symptoms prior to surgery and other covariates. However, particularly neurological dysfunction and disability may improve more with less invasive surgery.
Thomas Degen¹²³#, Karina Fischer¹²#, Robert Theiler¹², Stefan Schären⁴, Otto W Meyer¹²³, Guido Wanner⁵, Patricia Chocano-Bedoya¹², Hans-Peter Simmen³⁶, Urs D Schmid⁷, Johann Steurer⁸, Hannes B Stähelin⁹, and Heike A Bischoff-Ferrari¹²³*