Quality of Life in the Patients Treated for Degenerative Lumbar Spinal Stenosis: A Three-Year Follow-up Study

PURPOSE OF THE STUDY: The aim of the study was to evaluate the quality of life in patients treated for degenerative lumbar spinal stenosis at 3 years of follow-up. MATERIAL AND METHODS: Between October 2005 and 2008, answers to Oswestry, quality-of-life (SF-36) and VAS questionnaires were obtained from 117 patients indicated for lumbar spine surgery due to spinal stenosis. There were 52 men and 65 women, with an average age of 62 years. For future evaluation, the patients were placed into three groups according to the surgical treatment used: simple decompression with posterolateral fusion using autograft (69 patients); decompression and instrumented posterior fusion completed with autograft (21 patients); decompression and posterior dynamic stabilisation using the Dynesys system (27 patients). The patients were asked to respond to the three questionnaires again at 6, 12, 24 and 36 months of follow-up and to rate their willingness to undergo the surgery again on a 1-to-5 scale (from definitely yes to definitely no). RESULTS: In all three groups, the Oswestry disability index (ODI) significantly improved from the average pre-operative value of 53 to 39 post-operatively. This remained constant at 12 months (ODI 38), 24 months (ODI 38) and 36 months (ODI 37) after surgery. The SF-36 questionnaire also showed significant improvements in both categories covering components of physical and mental health. The VAS-based assessment of satisfaction with life and back and leg pain, however, did not provide such convincing results. The marking of satisfaction with surgery outcome was 1-2 in 71 % of the patients, and "only" 9.5 % of them would have never undergone the surgery again (marked 5). The L4-L5 segment was the most frequently treated region, and monosegmental decompression with fusion was the technique used most often. DISCUSSION: Our results are in agreement with the data reported in the national and international literature, including the number of patients studied and the results obtained from the Oswestry and SF-36 questionnaires. The assessment of life satisfaction using the VAS score has not been found in the literature. Our VAS back pain and leg pain scores slightly differed from the literature data, since no significant improvement in them was recorded. In assessing the patient's quality of life after lumbar spinal surgery, it is necessary to take into consideration also co-morbidities and external factors. CONCLUSIONS The results presented here show that lumbar spine surgery results in a significant improvement of life quality and has an irreplaceable role in the treatment of patients with degenerative spinal disease. However, three-year results do not provide enough evidence of the real stabilisation of patients' health state and thus the follow-up study is to be continued.