Correlation of Patient Satisfaction with Symptom Severity and Walking Ability after Surgical Treatment for Degenerative Lumbar Spinal Stenosis

Abstract

STUDY DESIGN: Prospective follow-up of 83 patients who had decompressive laminotomy with or without fusion for degenerative lumbar spinal stenosis between September 1992 and September 1998. OBJECTIVE: To evaluate the significance of the correlation between patient satisfaction and both the severity of postoperative symptoms and walking ability. SUMMARY OF BACKGROUND DATA: In clinical studies of surgery for degenerative lumbar spinal stenosis, patient satisfaction often is an item in the outcome questionnaire. However, little is known about the relationship of patient satisfaction to postoperative symptoms or functioning. METHODS: Patients completed standardized preoperative and follow-up questionnaires about symptom severity, walking ability, and their satisfaction with the results of surgical treatment. The significance of the correlation of patient satisfaction with the severity of postoperative symptoms and walking ability was evaluated. RESULTS: The mean length of follow-up was 39 months (range 12-84 months). The final questionnaire of a series was answered by 77 patients (93% of the cohort). By univariate analysis, the correlations of patient satisfaction with postoperative back pain, leg pain, numbness, subjective difficulty in walking, and walking ability were statistically significant (Spearman rank-order correlation coefficient: 0.58, 0.57, 0.53, 0.64, and 0.43, respectively). Postoperative walking ability was a weaker correlate of patient satisfaction than the severity of postoperative symptoms. By multivariate regression analysis, the only independent correlate was subjective difficulty in walking. CONCLUSIONS: In the evaluation of patient satisfaction as an outcome in patients operated on for degenerative lumbar spinal stenosis, we should keep in mind that postoperative functioning is a weak correlate of satisfaction.