J Korean Soc Spine Surg.  2018 Dec;25(4):160-168. 10.4184/jkss.2018.25.4.160.

Factors Associated with Conversion from Conservative to Surgical Treatment in Single-Level Lumbar Spinal Stenosis Patients

• Ahn YJ
• Im SH
• Park BK

• KMID: 2430141
• DOI: http://doi.org/10.4184/jkss.2018.25.4.160

Abstract

STUDY DESIGN: Retrospective study of prospectively-collected data.
OBJECTIVES
To determine the factors associated with conversion from conservative to surgical treatment in single-level lumbar spinal stenosis patients. SUMMARY OF LITERATURE REVIEW: Various reports have presented clinical outcomes after the surgical and nonsurgical treatment of spinal stenosis. However, few reports have investigated factors predicting conversion to surgery during the course of conservative treatment.
MATERIALS AND METHODS
We analyzed 40 patients who visited our hospital from May 2010 to May 2015 and were traceable for at least 3 years after being advised to undergo surgery following 3 months of conservative treatment. Of these patients, 20 underwent surgery and 20 did not. We then investigated the factors associated with conversion to surgical treatment. Clinical assessments were conducted using a questionnaire, and the overall area of the spinal canal and the muscle area within the spinal canal were measured using magnetic resonance imaging.
RESULTS
The average area of the spinal canal was 81.40±53.61 mm2 in the surgical group, compared to 127.75±82.55 mm2 in the nonsurgical group (p=0.042). The muscle area in the spinal canal was 5.17±1.30 cm2 in the surgical group, whereas it was 6.40±1.56 cm2 in the nonsurgical group (p=0.010). The patients in the surgical group were more likely to have experienced repetitive strain and to have frequently visited health clubs (p=0.047, p=0.037, respectively). However, regular stretching was more common in the nonsurgical group (p=0.028).
CONCLUSIONS
The factors associated with conversion to surgical treatment were a narrow spinal canal, a small muscle area within the spinal canal, visiting health clubs, repetitive sprain, and not stretching. A small muscle area within the spinal canal can be considered as a key factor related to surgical conversion.

Keyword

Lumbosacral region; Spinal stenosis; Amount of lumbar muscle

MeSH Terms

Fitness Centers
Humans
Lumbosacral Region
Magnetic Resonance Imaging
Retrospective Studies
Spinal Canal
Spinal Stenosis*
Sprains and Strains

Figure

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  Fig. 1. We measured the spinal canal dimensions using the free-line region of interest calculator of the Infinitt picture archiving and communication system for axial magnetic resonance images. These dimensions are represented as an inverted triangle on the image.

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  Fig. 2. The individual paraspinal muscles were outlined using the free-line region of interest calculator of the picture archiving and communication system. m1, m2: psoas major; m3, m4: quadrates lumborum; m5, m6: multifidus; m7, m8: erector spinae.

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  Fig. 3. Flow of the patients through each stage of the study.

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