AN IN-DEPTH ANALYSIS OF PATIENTS UNDERGOING SURGICAL TREATMENT FOR LUMBAR SPINAL STENOSIS PRESENTING WITH NEUROGENIC CLAUDICATION

Background: The connection between measurable clinical findings and patients' reported symptoms in cases of spinal stenosis, as well as how these relate to the extent of spinal canal narrowing, remains uncertain. This study aimed to assess individuals undergoing surgical treatment for lumbar spinal stenosis and intermittent neurogenic claudication through a combination of functional evaluations, quantitative imaging techniques, and patient-reported outcome measures. Methods- A total of 31 individuals diagnosed with lumbar spinal stenosis and neurogenic claudication were enrolled in this prospective study. Each participant underwent magnetic resonance imaging (MRI) before surgery and received decompressive surgical treatment, with follow-up lasting at least two years. Assessments included a walking performance test and patient-reported outcomes, using the Oswestry Disability Index and a visual analog scale for pain, both before and after the surgical procedure. Results- Before surgery, 25 patients (80.6%) exhibited symptom provocation during the walking test. Following surgery, this number dropped significantly to 5 patients (16.1%). The average preoperative scores on the Oswestry Disability Index and the visual analog pain scale were 58.4 and 7.1, respectively. After surgery, these averages significantly declined to 21.1 and 2.3 (p < 0.05). Imaging studies prior to surgery showed that 23 patients (74%) had central spinal stenosis. Of these, 20 had at least one spinal level with a dural tube cross-sectional area smaller than 100 mm², while 12 patients had two or more levels with areas below that threshold. Conclusions- In 80.6% of patients, a positive result on the walking test supported the diagnosis of spinal stenosis with neurogenic claudication prior to surgery. After lumbar decompression, the walking test indicated notable functional improvement. Additionally, postoperative scores on both the Oswestry Disability Index and the visual analog pain scale showed significant enhancement. The extent of central canal narrowing at a single spinal level did not seem to affect improvements in functional outcomes or self-reported assessments. Patients with stenosis at multiple levels tended to be older and covered shorter walking distances both before and after surgery; however, their gains in postoperative self-assessment were comparable to those observed in patients with single-level stenosis.