• Mitsuru Yagi, Satoshi Suzuki, Satoshi Nori, Yohei Takahashi, Osahiko Tsuji, Narihito Nagoshi, Masaya Nakamura, Morio Matsumoto, and Kota Watanabe.
• Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
• Spine. 2022 Apr 1; 47 (7): 557-564.

Study DesignMulticenter retrospective case series of patients treated surgically for lumbar spinal stenosis (LSS).ObjectiveWe investigated how laminectomy improves lower back pain (LBP) and the factors associated with poor improvement.Summary Of Background DataLumbar laminectomy is effective for alleviating neurological symptoms caused by LSS, whereas its effect on LBP is still controversial.MethodsA retrospective review of prospectively collected data from 436 patients (age 72 yrs, 69% males) who underwent laminectomy for LSS with 2 years of follow-up. We analyzed the following risk factors for residual LBP by uni- and multivariate analyses: age, sex, smoking, occupation, comorbidities, frailty, joint replacement, vertebral fracture, DISH, HRQOL, complications, and the presence of spinal instability. The LBP of male and female patients was analyzed after propensity score matching of known confounders. Patient-reported outcomes (JOABPEQ and VAS scores) were obtained at baseline and the 2-year postoperative follow-up.ResultsLBP was significantly improved at 2 years post operation (VAS change 2.3 [95% CI 2.0-2.6], P < 0.01). Fifty-five percent of the patients achieved an MCID, with 67% having no or mild LBP. In the multivariate analysis, sex and baseline LBP were independent risk factors (female: OR 1.9 [1.2-3.0], baseline LBP [VAS≥7.5]: OR 1.9 [1.2-3.1]). Furthermore, the independent risk factors for severe baseline LBP were sex and mental status (female: OR 1.7 [1.1-2.7], P = 0.03, mental status: OR 3.8 [2.4-6.0], P < 0.01). However, an analysis of 102 pairs of propensity-score-matched male and female patients showed no difference in the improvement of LBP (male vs. female: VAS 3.8 ± 2.8 vs. 4.0 ± 2.9, P = 0.61, VAS change 3.1 ± 2.9 vs. 2.7 ± 3.0, P = 0.38).ConclusionDecompression surgery for LSS significantly improved LBP. Sex and baseline LBP were risk factors for residual LBP. However, when males and females were matched by confounders, no difference was found in the LBP after surgery. Patients with severe baseline LBP may need further evaluation for their mental status because these patients are likely to have mental problems that potentially contribute to persistent LBP.Level of Evidence: 4.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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