Clinical StudyProspective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis
Introduction
Clinical outcomes after decompression surgery for degenerative lumbar canal stenosis have most commonly been assessed with traditional, objective outcome measures. These measures include neurological findings, radiographic evaluation, and the Japanese Orthopaedic Association (JOA) scoring system for low back pain (Table 1). Subjective evaluations by patients, however, are becoming increasingly important for measuring surgical outcome because many modern procedures are performed primarily to improve a patient's quality of life. Currently available instruments for assessing quality of life include the Short-Form 36 (SF-36) [1], [2] questionnaire for generic health status, the Oswestry disability index (ODI) [3], [4], [5] for low back pain, and the visual analog scale (VAS, a clinical pain scale). The purpose of this study was to validate various subjective and objective measures of surgical outcome, including patient self-assessment and psychological changes after surgery. The study also analyzed the validity of the JOA scoring system and determined the degree of correlation between VAS pain scale scores and SF-36 Version 2 (SF-36v2), ODI Version 2 (ODIv2), and JOA scores.
Section snippets
Patients and methods
We conducted a prospective study of 42 patients (20 men and 22 women) undergoing surgical treatment with a mean age of 66.8±10.9 years ranging from 33 to 88 years at the time of surgery. All patients gave their informed consent to participate in this study, which had been approved by the institutional review board of our school of medicine (no. 183). Surgical indications included no response to conservative treatment including medications or physical therapy and neurological deterioration
Results
The overall JOA scores as well as the subscores for subjective symptoms, clinical signs with the exception of urinary dysfunction, and restriction of ADLs were all significantly improved 24 months postoperatively when compared with the corresponding preoperative scores (Fig. 1). The SF-36v2 scores for all subscales were also significantly higher after surgery (Fig. 2). Although the physical component subset showed significant improvement, all scores were less than the Japanese adjusted norms.
Discussion
In this study, all JOA, SF-36v2, ODI-v2, and VAS measures significantly improved postoperatively. The JOA score for low back pain is composed of four categories of subjective symptoms, clinical signs, restriction of ADLs, and urinary dysfunction. Three categories, subjective symptoms, clinical signs, and restriction of ADLs showed significant improvement postoperatively, whereas there was no postoperative change in the score for urinary dysfunction. This is likely because the patients enrolled
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