Does the Severity of Foraminal Stenosis Impact Outcomes of Lumbar Decompression Surgery?

• Published in: World neurosurgery 2023-11, Vol.179, p.e296-e304
• Main Authors: Heard, Jeremy C., Lee, Yunsoo, Ezeonu, Teeto, Lambrechts, Mark J., Issa, Tariq Z., Yalla, Goutham R., Tran, Khoa, Singh, Akash, Purtill, Caroline, Somers, Sydney, Becsey, Alexander, Canseco, Jose A., Kurd, Mark F., Kaye, Ian D., Hilibrand, Alan S., Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K.
• Format: Article
• Language: English
• Subjects: Constriction, Pathologic - diagnostic imaging; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Decompression, Surgical - methods; Degenerative; Humans; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Motor exam; Neuroforaminal stenosis; Patient-reported outcomes; Radiculopathy; Radiculopathy - diagnostic imaging; Radiculopathy - etiology; Radiculopathy - surgery; Retrospective Studies; Spinal Stenosis - complications; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - surgery; Surgical outcomes; Treatment Outcome
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.08.081

To establish the relationship between the magnitude of foraminal stenosis and 1) improvement in patient-reported outcomes, 2) improvement in motor function after lumbar decompression surgery, and 3) difference in surgical outcomes. Patients who underwent one-level posterior lumbar decompression for radiculopathy were retrospectively identified. Patient demographics and surgical characteristics were collected through a query search and manual chart review of the electronic medical records. Foraminal stenosis was determined on magnetic resonance imaging and graded using Lee et al.'s validated methodology as none, mild, moderate, or severe. Surgical outcomes, motor function, and patient-reported outcome measures (PROMs) were compared based on the amount of stenosis (mild vs. moderate vs. severe). Bivariant and multivariant analyses were performed. Severe stenosis demonstrated more 90-day readmissions (0.00% vs. 0.00% vs. 8.57%, respectively, P = 0.019), though this effect did not remain significant on multivariate analysis (P = 0.068). There was no association between stenosis severity and the degree of functional impairment or PROMs preoperatively. Patients with moderate or severe preoperative foraminal stenosis showed improvement in all PROMs after surgery (P < 0.05) except the mental component of the Short Form 12 survey. Notably, central stenosis grade was insignificantly different between groups (P = 0.358). Multivariable logistic regression analysis did not identify any significant independent predictors of surgical outcomes or changes in PROMs. We demonstrated that regardless of foraminal stenosis severity preoperatively, patients have a similar improvement in PROMs, surgical outcomes, and restoration of motor function after lumbar decompression surgery for radiculopathy.