Predictors for Unsuccessful Outcome of Lumbar Spinal Stenosis Surgery: A Secondary Analysis of the 2 Randomized NORDSTEN Trials

Aline A Nomeland; Erik A M Brekke; Andreas O Seip; Tor Åge Myklebust; Eira K Ebbs; Tore Solberg; Erland Hermansen; Kari Indrekvam; Kjersti Storheim; Ole K Alhaug; Clemens Weber; Christian Hellum; Eric Franssen; Inger Ljøstad; Helena Brisby; Håvard Furunes; Elisabeth Lilleholt; Ivar M Austevoll

doi:10.1097/BRS.0000000000005642

Predictors for Unsuccessful Outcome of Lumbar Spinal Stenosis Surgery: A Secondary Analysis of the 2 Randomized NORDSTEN Trials

Spine (Phila Pa 1976). 2026 Apr 15;51(8):527-533. doi: 10.1097/BRS.0000000000005642. Epub 2026 Jan 30.

Authors

Aline A Nomeland¹, Erik A M Brekke¹, Andreas O Seip², Tor Åge Myklebust^{3

4}, Eira K Ebbs⁵, Tore Solberg^{6

7}, Erland Hermansen^{3

4}, Kari Indrekvam^{2

8}, Kjersti Storheim^{9

10}, Ole K Alhaug^{11

12}, Clemens Weber¹³, Christian Hellum^{14

15

8}, Eric Franssen¹⁶, Inger Ljøstad¹⁷, Helena Brisby^{18

19}, Håvard Furunes^{20

21}, Elisabeth Lilleholt²², Ivar M Austevoll²

Affiliations

¹ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
² Department of Orthopedics, Kysthospitalet in Hagevik, Haukeland University Hospital, Hagavik, Norway.
³ Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
⁴ Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.
⁵ Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
⁶ Institute of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway.
⁷ The Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway.
⁸ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁹ Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
¹⁰ Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
¹¹ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹² Department of Orthopaedic Surgery, Innlandet Hospital Trust, Tynset, Norway.
¹³ Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
¹⁴ Department of Orthopedics, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
¹⁵ Department of Orthopedics, Oslo University Hospital, Ullevål, Oslo, Norway.
¹⁶ Department of Orthopaedics, Stavanger University Hospital, Stavanger, Norway.
¹⁷ Norwegian Back and Spine Patients Association.
¹⁸ Department of Orthopaedics, Spine Surgery Team, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁹ Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
²⁰ Department of Orthopaedics, Innlandet Hospital Trust, Gjøvik, Norway.
²¹ Faculty of Medicine, University of Oslo, Oslo, Norway.
²² Department of Physical Therapy, Sørlandet Hospital Arendal, Arendal, Norway.

PMID: 41626785
DOI: 10.1097/BRS.0000000000005642

Abstract

Study design: Observational cohort study.

Objective: To evaluate potential predictors of unsuccessful outcomes after surgery in patients with lumbar spinal stenosis (LSS).

Summary of background data: LSS is a common cause of disability in adults and the leading indication for spine surgery in Norway. Despite advances in surgical techniques, nearly one-third of patients report either minor or no improvement or worsening of symptoms after surgery. Identifying predictors of unsuccessful outcomes is essential for improving patient selection and shared decision-making.

Materials and methods: This secondary analysis used data from the 2 NORwegian Degenerative spondylolisthesis and spinal STENosis (NORDSTEN) randomized trials, which included 704 surgically treated patients with LSS, with (n=267) or without (n=437) degenerative spondylolisthesis. The Oswestry Disability Index (ODI) was the primary outcome measure. A reduction in ODI score of <30% from baseline to 2 years postoperatively was defined as an unsuccessful outcome. Multivariable logistic regression analysis was used to evaluate whether carefully selected baseline variables were associated with an unsuccessful outcome at 2-year follow-up.

Results: Longer duration of radiating pain (>12 mo; OR: 2.58, 95% CI: 1.54-4.29), psychological distress (HSCL-25 ≥1.75; OR: 1.60, 95% CI: 1.01-2.53), and advanced disc degeneration (Pfirrmann grades 4-5; OR: 1.98, 95% CI: 1.26-3.12) were independently associated with an unsuccessful outcome. Commonly discussed factors such as age, BMI, smoking, ASA grade, and predominant back pain did not reach statistical significance for association with the outcome.

Conclusion: Among patients undergoing surgery for LSS, longer symptom duration, psychological distress, and advanced disc degeneration were associated with a higher risk of unsuccessful postoperative outcomes.

Keywords: HSCL-25; Pfirrmann; degenerative spondylolisthesis; disability; outcome; predictor; prognosis; spinal stenosis.

Publication types

Observational Study
Randomized Controlled Trial

MeSH terms

Aged
Cohort Studies
Female
Humans
Lumbar Vertebrae* / surgery
Male
Middle Aged
Norway / epidemiology
Randomized Controlled Trials as Topic
Spinal Stenosis* / epidemiology
Spinal Stenosis* / surgery
Spondylolisthesis* / surgery
Treatment Failure
Treatment Outcome