Pre-operative prognostic factors for walking capacity after surgery for lumbar spinal stenosis: a systematic review.
Study Goal
The researchers aimed to identify pre-operative prognostic factors (both mutable and immutable) associated with post-operative walking capacity in adults with lumbar spinal stenosis (LSS).
Results Summary
The study found moderate-quality evidence that greater pre-operative walking capacity is positively associated with post-operative walking capacity, while spondylolisthesis and severity of stenosis were not associated. Most other factors had low or very low evidence levels.
Population
Adults receiving surgery for lumbar spinal stenosis (LSS).
Effective Dosage
Not available
Duration
Not available
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
surgery for LSS | decrease | walking | older people | 40% | reduces | #1 |
pre-operative walking capacity | increase | post-operative walking capacity | adults with LSS | - | was positively associated with | #2 |
the presence of spondylolisthesis | no change | post-operative walking capacity | adults with LSS | - | was not associated with | #3 |
the severity of stenosis | no change | post-operative walking capacity | adults with LSS | - | was not associated with | #4 |
BACKGROUND: Lumbar spinal stenosis (LSS) reduces walking and quality of life. It is the main indication for spinal surgery in older people yet 40% report walking disability post-operatively. Identifying the prognostic factors of post-operative walking capacity could aid clinical decision-making, guide rehabilitation and optimise health outcomes. OBJECTIVE: To synthesise the evidence for pre-operative mutable and immutable prognostic factors for post-operative walking in adults with LSS. DESIGN: Systematic review with narrative synthesis. METHODS: Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, OpenGrey) were searched for observational studies, evaluating factors associated with walking after surgery in adults receiving surgery for LSS from database inception to January 2020. Two reviewers independently evaluated studies for eligibility, extracted data and assessed risk of bias (Quality in Prognosis Studies). The Grading of Recommendations Assessment, Development and Evaluation method was used to determine level of evidence for each factor. RESULTS: 5526 studies were screened for eligibility. Thirty-four studies (20 cohorts, 9,973 participants, 26 high, 2 moderate, 6 low risk of bias) were included. Forty variables (12 mutable) were identified. There was moderate quality of evidence that pre-operative walking capacity was positively associated with post-operative walking capacity. The presence of spondylolisthesis and the severity of stenosis were not associated with post-operative walking capacity. All other factors investigated had low/very low level of evidence. CONCLUSION: Greater pre-operative walking is associated with greater post-operative walking capacity but not spondylolisthesis or severity of stenosis. Few studies have investigated mutable prognostic factors that could be potentially targeted to optimise surgical outcomes.