The Role of Endoscopic Spinal Decompression Surgery in Amelioration of Disability in Patients with Lumbar Spinal Stenosis

Background. Degenerative lumbar spinal stenosis (LSS) is a common cause of chronic low back pain (LBP) and is often associated with various degrees of disability. Endoscopic spinal decompression (ESD) is a minimally invasive surgical approach for treating degenerative LSS. However, the impact of ESD on the rehabilitation of disability in patients with LSS remains unclear. Material and methods. Patients with LSS who underwent ESD surgery were selected prospectively. The disability status was evaluated as the Oswestry Disability Index (ODI) using a standard Oswestry LBP disability questionnaire pre- and post-surgery and at 1-year follow-up. Based on pre-surgical ODI, patients were classified into mild and moderate-to-severe disability groups. Results. A total of 93 patients with LSS who underwent ESD surgery (mean age5514 and female 55%) were included. Fourteen patients were classified into a mild disability group, while 79 patients were placed in a moderate-to-severe disability group. Pre-surgical ODI scores were significantly lower in the mild disability group compared to the moderate-to-severe disability group (17, IQR 13-19 vs. 31, IQR 25-35, p<0.001). After ESD surgery, ODI was significantly reduced in both mild (17, IQR 13-19 vs. 3, IQR 0-4, p=0.016) and moderate-to-severe disability groups (3, IQR 0-4 vs. 2, IQR 1-5, p<0.001). Post-surgical ODI scores were similar between the study groups (3, IQR 0-4 vs. 2, IQR 1-5, p=0.656). These improvements in ODI were maintained at the 1-year follow-up in the mild (3, IQR 0-4 vs. 2, IQR 0-8, p=0.766) and moderate-to-severe disability groups (2, IQR 1-5 vs. 3, IQR 1-5, p=0.078). The 1-year ODI scores remained comparable between the mild and moderate-to-severe disability groups (2, IQR 0-8 vs. 3, IQR 1-5, p=0.581) Conclusions. 1. Endoscopic spinal decompression surgery is associated with significant improvements in disability, as measured by the Oswestry Disability Index, in both mild and moderate-to-severe disability patients. 2. Post-surgical amelioration of disability is sustained for at least one year following the surgery. 3. These findings support the use of early intervention with minimally invasive endoscopic spinal decompression in mild disability patients with degenerative lumbar spinal stenosis.