The clinical course of symptoms during wait time for lumbar spinal stenosis surgery and its effect on postoperative outcome: a retrospective cohort study

Abstract

Background context: Wait time for surgeries can be lengthy and its effect on postoperative outcome remains largely unknown.

Purpose: We evaluated the effect of wait time on postoperative outcome and on clinical course while awaiting surgery for lumbar spinal stenosis.

Study design/setting: This was a retrospective cohort study.

Patient sample: A convenience sample (n=134) from prospective longitudinal studies that provided preoperative Oswestry Disability Index (ODI) data at two different time points and follow-up of ≥12 months.

Methods: Wait time was the period between the initial consultation and immediately preoperatively.

Outcome measures: The primary outcome was the ODI minimal clinically important difference (MCID) (<30% vs ≥30% improvement) at 1 year.

Results: The median wait time was 5.9 (interquartile range (IQR) 8.2) months and postoperative follow-up was 19.2 (IQR 8.1) months. Wait time was not associated with absolute postoperative change in ODI scores, but patients with wait times <12 months were significantly more likely to reach the ODI MCID at last follow-up (66 (73.3%) for <12 months versus 13 (46.4%) for ≥12 months, p=.008; odds ratio=0.29 (95% confidence interval 0.12-0.75), p=.011). During wait time, there was no difference in patients deteriorating above the MCID for each time point (10 [9.7%] versus 5 [16.1%], p=.320).

Conclusions: Longer wait times did not negatively influence postoperative outcome in patients with lumbar spinal stenosis using absolute values, but may impact individual patients' ability to achieve MCID. Patient-reported pain-related disability from the initial surgical consultation to surgery is relatively stable in most patients for at least 6 to 12 months.

Keywords: Lumbar; Outcome; Spinal stenosis; Surgery; Wait time.