Usefulness of the lumbar spinal stenosis-specific symptom scale: Evaluation of surgical efficacy

Transcription

1 Usefulness of the lumbar spinal stenosis-specific symptom scale: Evaluation of surgical efficacy Watanabe K, Otani K, Nikaido T, Kato K, Kobayashi H, Sekiguchi M, Yabuki S, Kikuchi S, Konno S Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan COI disclosure: Nothing to disclose

2 Introduction The lumbar spinal stenosis (LSS)-specific symptom scale (FLS-25 [Fukushima LSS Scale 25]) is a self-administered questionnaire designed to comprehensively cover various symptoms of LSS. The FLS-25 was developed to address the need to measure symptoms specific to this disorder. Sekiguchi et al. Spine 2012,2014 The purpose of this study was to clarify the usefulness of the FLS- 25 for evaluating the surgical efficacy of lumbar decompression for LSS.

3 FLS-25 Domain Stairs Stairs Stretching Standing Stretching Sleeping Turning Stairs Rest Standing TurningI Stretching Others Rest Sleeping Sleeping Others Numbness Others Numbness Item I have difficulty walking down stairs. I have difficulty walking up stairs. I can t stretch my back. I can't do work or chores where I have to stand in one place. I can only walk slowly. I can't twist my body to look above or behind me. I can't turn over in bed. Sitting back up from a lying position requires effort. When walking up or down stairs, I must use the handrail. Numbness or pain bothers me even when I'm eating. If I stand for a while, I feel numbness or pain and cannot keep standing. sometimes stagger when I stand up or sit down. I can't walk because it makes me feel exhausted. When I stretch my back, my symptoms get worse. I cannot walk unless I bend forward. I spend most of the day lying down due to pain or numbness. Sometimes when I try to walk, I can't move my legs forward and I almost fall. Sometimes numbness or pain interferes with my ability to concentrate on things. If I walk for a while, my symptoms worsen and I can't walk anymore. I can't lie on my back. I sometimes have leg cramps when I lie down to sleep. My symptoms are worst when I wake up in the morning. When I am sleeping, the ends of my feet feel cold. When I can't walk any further, I can walk again after resting for a short while. I often have no feeling in my legs. Sekiguchi M et al Spine 37: ,2012

4 Materials and Methods Patients A total of 120 consecutive LSS patients underwent laminotomy (73 men, 47 women; predominant age group, 70s) Outcome The FLS-25 (0 100, higher scores indicating worse condition) Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) Numerical rating scales of low back pain (LBP), leg pain, and leg numbness (0 10, higher scores indicating worse pain) The satisfaction with surgery (0: unsatisfied, 10: completely satisfied) Follow-up period One year

5 Results Before 1 year Change of the score FLS-25 61(1-100) 47(0-93) 18.6 (19.0) Symptoms NRS of LBP 4(0-10) 1 (0-8) 2.8 (1.5) NRS of leg pain 5(0-10) 2 (0-9) 3.9 (2.1) NRS of leg numbness 6(0-10) 4 (0-10) 2.8 (3.5) JOABPEQ Low back pain 28.6(0-100) 71.4 (0-100) 28.0 (38.1) Lumbar function 50.0(0-100) 66.7 (0-100) 9.2 (31.4) ability 21.4(0-100) 46.4 (0-100) 27.3 (31.7) Social function 27.0(0-83.8) 40.5 (0-100) 18.5 (21.8) Mental health 44.7(0-90.3) 54.4 (0-96.1) 11.9 (15.0) Median (minimum-maximum) Average (standard deviation)

6 Scores before surgery FLS-25 61(1-100) Correlation coefficient vs FLS-25 score P value Symptoms NRS of LBP 4(0-10) NRS of leg pain 5(0-10) NRS of leg numbness 6(0-10) JOABPEQ Low back pain 28.6(0-100) < Lumbar function 50.0(0-100) < ability 21.4(0-100) < Social function 27.0(0-83.8) < Mental health 44.7(0-90.3) <0.0001

7 Scores 1 year after surgery FLS-25 47(0-93) Correlation coefficient vs FLS-25 score P value Symptoms NRS of LBP 1 (0-8) 0.53 < NRS of leg pain 2 (0-9) NRS of leg numbness 4 (0-10) 0.61 < JOABPEQ Low back pain 71.4 (0-100) < Lumbar function 66.7 (0-100) < ability 46.4 (0-100) < Social function 40.5 (0-100) < Mental health 54.4 (0-96.1) < Satisfaction with surgery 8 (2-10) <0.0001

8 Change of the score FLS (19.0) Correlation coefficient vs the change of FLS-25 P value Symptoms NRS of LBP 2.8 (1.5) NRS of leg pain 3.9 (2.1) NRS of leg numbness 2.8 (3.5) JOABPEQ Low back pain 28.0 (38.1) 0.46 < Lumbar function 9.2 (31.4) ability 27.3 (31.7) 0.48 < Social function 18.5 (21.8) 0.44 < Mental health 11.9 (15.0) 0.47 < Satisfaction with surgery 8 (2-10) 0.44 <0.0001

9 Conclusion The FLS-25 score correlated with every symptom scale and with every JOABPEQ subscale before and 1 year after surgery. The postoperative change of FLS-25 correlated with the change of NRS for LBP and leg numbness, with the change of every JOABPEQ subscale, and with satisfaction. FLS-25 could comprehensively evaluate the severity of LSS and efficacy of surgery for LSS symptoms.