• Mitsuru Yagi, Satoshi Suzuki, Satoshi Nori, Eijiro Okada, Osahiko Tsuji, Narihito Nagoshi, Masaya Nakamura, Morio Matsumoto, and Kota Watanabe.
• Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
• Spine. 2021 Aug 15; 46 (16): 111811271118-1127.

Study DesignRetrospective review.ObjectiveThis study sought to determine how baseline motor weakness (MW) affects elective spine surgery in patients with degenerative lumbar spinal stenosis (LSS).Summary Of Background DataFavorable clinical outcomes have been described for elective spine surgery in patients with LSS. However, the way preoperative MW affects the patient's health-related quality of life (HRQoL) after surgery is not well understood.MethodsA retrospective review of prospectively collected data from 305 surgically treated patients with LSS who had 2-year follow-up was performed (age 71 ± 9 yrs, male 62%). Demographic, radiographic, and clinical outcomes were analyzed at baseline and at 1-year, 2-year, and 3-year postoperation. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire was used to assess the HRQoLs. The HRQoLs were compared between those with or without preop MW. Adjusted multivariate logistic regression analyses were performed to determine whether MW affected HRQoLs.ResultsOne hundred sixteen patients (38%) were categorized as MW+. The patient background including age, sex, presence of degenerative spondylolisthesis, type of surgery, and presence of neurological claudication were similar between the two groups. However, the 1-, 2-, and 3-year postoperative visual analogue scale of back pain, leg pain, leg numbness, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire lumbar function, social life, mental health, and walking ability were all inferior in the MW+ group, whereas a similar percentage of patients achieved a minimum clinically important difference in all subdomains at 3 years. The adjusted multivariate logistic regression analyses showed that having ≥2 muscles with MW, and severity of MW (manual motor test grade) were independent risk factors for both difficulty climbing stairs and walking >15 minutes. (muscles with MW≥2; stair climbing: OR 6.4[2.3-17.4], walking: OR 3.2[1.4-7.3], severity of MW; stair climbing: OR 2.5[1.4-4.4], walking: OR 2.2[1.3-3.7]).ConclusionThe patients with baseline MW had inferior HRQoL for up to 3 years compared with that of those without MW; however, the amount of improvement in HRQoL was comparable. Timely follow-up is important to find out the deterioration of motor function.Level of Evidence: 4.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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