Decision Making Process in Patients With Lumbar Spinal Canal Stenosis

Parisa Azimi, Shirzad Azhari, Edward C Benzel, Sohrab Shahzadi


Background: To develop a strategy to determine a sound method for decision making in lumbar spinal canal stenosis (LSCS), based on postoperative patient satisfaction.

Materials and Methods: A sample of patients with LSCS was studied to indicate those who underwent surgery and those who received conservative treatment. The SSS, the NCOS, and the ODI tools were recorded. Satisfaction of patients who underwent surgery or conservative was evaluated prospectively using the satisfaction Index presented by Stucki et al. Then, all case records were assessed for morphology grade and dural sac cross-sectional surface area (DSCA) on MRI in order to indicate who benefited from surgery or conservative and who did not.

Results: The mean age of 357 patients was 57.5 (10.9) years. Of these 176 patients underwent surgery. Post-treatment satisfaction was found for surgical group patients (93.2%) and conservative group patients (84.5%) at last follow-up. Most patients (86.4%) who underwent surgery identified as having grade C and grade D while those who received conservative treatment were identified as having grade A and grade B (P < 0.01). Overall satisfaction with surgery was found to be higher among patients with Grade D stenosis (95%). Satisfaction by cross-sectional surface area did not show a consistent pattern. However, those with cross-sectional surface area less than 100 mm2 benefited more from surgery. According to the findings a decision matrix was proposed.

Conclusion: The findings suggest that the morphology grade and the DSCA jointly are useful parameters for helping clinicians to make decision in order to manage LSCS patients.

 Keywords: Decision making, DSCA, grading stenosis, LSCS