Factors Associated with the Effect of Conservative Treatment in Surgically Indicated Single-Level Lumbar Spinal Stenosis Patient

Young-Joon Ahn; Se-Hyuk Im; Seok-In Jang

doi:10.4184/jkss.2019.26.4.151

Journal List > J Korean Soc Spine Surg > v.26(Suppl 1) > 1142096

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Ahn, Im, and Jang: Factors Associated with the Effect of Conservative Treatment in Surgically Indicated Single-Level Lumbar Spinal Stenosis Patient

Original Article

Journal of Korean Spine Surg 2019;26(4):151-159.

Published online: 31 December 2019

DOI: https://doi.org/10.4184/jkss.2019.26.4.151

Factors Associated with the Effect of Conservative Treatment in Surgically Indicated Single-Level Lumbar Spinal Stenosis Patient

Young-Joon Ahn, M.D., Se-Hyuk Im, M.D., Seok-In Jang, M.D.

Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea

Corresponding author: Young-Joon Ahn, M.D. ORCID ID: Young-Joon Ahn: https://orcid.org/0000-0003-4999-650X Se-Hyuk Im: https://orcid.org/0000-0003-3329-7923 Seok-In Jang: https://orcid.org/0000-0002-0514-2636 Department of Orthopedic Surgery, National Police Hospital, 58, Garakbon-dong, Songpa-gu, Seoul, National Police Hospital, Seoul, Korea TEL: +82-2-3400-1246, FAX: +82-2-3400-1249 E-mail: osahnyj@nate.com

Received 1 October 20191 October 2019 Accepted 26 December 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study of date collected prospectively.

Objectives

To report analytic results about association factors related to effect of conservative treatment in surgically indicated single level lumbar spinal stenosis patient.

Summary of Literature Review

There have been various reports about clinical outcomes and relative factors after surgical treatment of spinal stenosis. However, there are few reports about factors related to effect of conservative treatment in surgically indicated lumbar spinal stenosis patient.

Materials and Methods

We based on 40 patients who had visited our hospital from May 2010 to April 2016 who were traceable for at least three years. We analysed 20 patients who improved symptom and who didn't improved symptom then investigated association factors related to effect of conservative treatment. Clinical assessment was conducted using questionnaire and spinal canal's area and muscle amount were measured in the MRI.

Results

Average of the spinal canal of not-improved group is 91.29(±34.26) mm², improved group is 130.70 (±32.18) mm² and impoved group is wider (p=0.001). Muscle mass of improved group is 91.47(±9.43) cm², not-improved group is 79.26 (±14.35) cm², and improved group is wider (p=0.003). Repetitive strain and traffic accident were related in not-improved group (p=0.028). However, practiced stretching continuously were related to symptom improvement (p=0.022).

Conclusions

Association factors related to effect of conservative treatment are cases of wide spinal canal, wide muscle amount, repetitive sprain, traffic accident and stretching. A small muscle amount can be considered as a key factor related to surgical conversion.

Keywords: Lumbosacral region, Spinal stenosis, Paraspinal muscle

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Fig. 1.

Flow of the patients through each stage of the study.

Fig. 2.

We measured the spinal canal dimension using free line ROI cal-culator calculator.

Fig. 3.

We measured the paraspinal muscles using free line ROI calcula-tor calculator. M1: psoas major, M2: quadrates lumborum, M3: erector spinae, M4: multifidus.

Table 1.

Base line characteristics, compared between the patients with conservative treatment in sugically indicated single-level lumbar spinal stenosis patient

Base line underlying factors	Improved (n=20)	Not improved (n=20)	p-value
Age (years), mean (SD)	62.10±9.58	65.55±9.93	0.500
Gender (Male)	19	18	0.548
Body mass index (kg/m²), mean (SD)	25.40±2.81	25.75±3.12	0.338
Comorbid illnesses
Hypertension	15	17	0.429
MI	3	3	1.000
Arrythemia	0	2	0.147
Hyperlipidemia	5	4	0.705
BPH	2	3	0.633
Stroke	0	1	0.311
DM	7	5	0.490
CKD	0	2	0.147
Alcohol use	11	8	0.342
Cigarette use (current or quit in past 6months)	6	4	0.465
Educational background (At least a college graduate)	6	2	0.114
Work related features (Employed)	13	11	0.519
Residence type (Alone)	1	0	0.311
Activity
Walking	11	6	0.110
Running	1	3	0.292
Bicycle	5	3	0.429
Hiking	2	4	0.376
Golf	3	1	0.292
Fitness	4	3	0.273
Back Stretching	11	4	0.022
Trauma history	2	8	0.028
Traffic/Industrial accident	0	4	0.035
Spinal stenosis Family history	2	2	1.000

Table 2.

Base line characteristics, compared between the patients with conservative treatment in sugically indicated single-level lumbar spinal stenosis patient

Base line clinical factors	Improved (n=20)	Not improved (n=20)	p-value
Level affected on MRI
L3-L4	1	0	0.311
L4-L5	19	20	0.311
Spinal canal dimension (mm²), mean (SD)	130.70±32.18	91.29±34.26	0.001
<73.1	0	8
73.1-172.5	18	12
≥172.5	2	0
Paraspinal muscle(cm2), mean (SD)	91.47±9.43	79.26±14.35	0.003
Degenerative spondylolisthesis (<5 mm)	17	13	0.219
Scoliosis (<15°)	20	19	0.311
Conservative treatment
Physical therapy	10	13	0.433
Medication	17	20	0.072
Trigger point injection	1	0	0.311
ESWT	0	0
Manual therapy	3	1	0.292
Nerve block (<5)	12	8	0.205

Table 3.

Inter-observer Reliability for cross sectional area (csa) of spinal canal and paraspinal muscle on mri

Measurement parameters	Inter-observer ICC∗
CSA of Spinal canal	0.847
CSA of Paraspinal muscle	0.886

ICC: Intraclass correlation coefficient.

Table 4.

Simple and multiple linear regression analysis of associated factors of conservative treatment

Base line factors	Simple			Multiple
Base line factors	Coefficient	SE	p-value	Coefficient	SE∗	p-value
Spinal canal dimension (mm²)	−0.032	0.013	0.014	−0.028	0.12	0.026
Paraspinal muscle (cm²)	−0.001	<0.001	0.010	−0.001	<0.001	0.019

SE: Standard error.

Table 5.

Changes of K-ODI, VAS over time in improved and not-improved groups

	VAS∗ score			K-ODI∗ score
	Improved	Not improved	p-value	Improved	Not improved	p-value
OP recommend	6.95±1.40	5.40±2.37	0.016	17.85±6.89	15.69±7.59	0.332
After 3years	2.40±1.67	6.20±2.12	<0.05	6.30±4.87	16.10±7.35	<0.05

VAS: Visual analogue scale. K-ODI: Korean oswestry disability index.

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