medRxiv · Feb 15, 2023
The impact of spinal surgery on the locomotive syndrome in patients with lumbar spinal stenosis in CDL stage 3: a retrospective study
By Nakae I, Hashida R, Otsubo R et al.
Abstract Objectives Locomotive syndrome (LS) is characterized by reduced mobility. Clinical decision limit (CDL) stage 3 in LS indicates physical frailty. Lumbar spinal canal stenosis (LSS) is one cause of LS, for which lumbar surgery is considered to improve the CDL stage. This study aimed to investigate the efficacy of lumbarsurgery and independent factors for improving CDL stage in patients with LSS. Design A retrospective study Setting The study was conducted at the Department of Orthopaedic Surgery at University Hospital. Participants A total of 157 patients aged ≥ 65 years with LSS underwent lumbar surgery. Interventions The 25-Question Geriatric Locomotive Function scale (GLFS-25) was used to test for LS, and the timed up and go test (TUG) was used to evaluate functional ability. Lower limb pain was evaluated using a visual analog scale. Patients with at least one improvement in CDL stage following lumbarsurgery were included in the improvement group. Differences in lower-limb pain intensity between the groups were evaluated using the Wilcoxon rank-sum test. The Spearman’s rank correlation coefficient was used to determine correlations between Δ lower limb pain and Δ GLFS-25. Logistic regression analysis was used to identify factors associated with improvement in LS. Results The proportion of patients with improved CDL stage was 45.1% (improvement/non-improvement: 32/39). Δ Lower limb pain was significantly reduced in the improvement group compared to that in the non-improvement group (51.0 [36.3-71.0] vs 40.0 [4.0-53.5]; p =0.0107). Δ GLFS-25 significantly correlated with Δ lower-limb pain (r =0.3774, p =0.0031). In a multiple logistic regression analysis, TUG and age were significantly associated with improvement in LS (odds ratio, 1.22; 95% confidence interval: 1.07-1.47). Conclusions The lumbar surgery effectively improved the CDL stage in patients with LSS. In addition, TUG was an independent factor associated with improvement in the CDL. Strengths and limitations of the study The Japanese Orthopaedic Association defines locomotive syndrome as patients with reduced motor function. We reported the effect of surgical treatment on clinical decision limit 3 (CDL3), which corresponds to physical frailty. We investigated improvement factors for locomotive syndrome CDL stage 3 in patients with lumbar spinal stenosis in a retrospective study. Seventy-one patients who underwent surgical treatment were included in the study. Factors associated with improvement in locomotive syndrome were analyzed using multivariate logistic analysis and decision tree analysis.