Associations between treatment and health-related quality of life in patients with symptomatic lumbar spinal stenosis: a retrospective propensity score-matched analysis in the Locomotive syndrome and health outcome in Aizu cohort study (LOHAS) database — The International Society for the Study of the Lumbar Spine
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Associations between treatment and health-related quality of life in patients with symptomatic lumbar spinal stenosis: a retrospective propensity score-matched analysis in the Locomotive syndrome and health outcome in Aizu cohort study (LOHAS) database (#1238)

Takeru Yokota 1 , Kinshi Kato 1 , Koji Otani 1 , Miho Sekiguchi 1 , Shoji Yabuki 1 , Takuya Nikaido 1 , Kazuyuki Watanabe 1 , Hiroshi Kobayashi 1 , Ryoji Tominaga 2 , Shin-ichi Konno 1
  1. Fukushima Medical University, Fukushima, FUKUSHIMA, Japan
  2. Orthopaedic, Aizu medical center, Aizu, Fukushima, Japan

INTRODUCTION:

Since prospective cohort studies that have to follow symptomatic lumbar spinal stenosis (LSS) patients who do not receive treatment must not be planned due to ethical considerations, the natural course for the untreated LSS patients was uncertain. The purpose of the present study was to investigate the association between treatment and health-related quality of life (HR-QOL) in patients with symptomatic LSS.

METHODS:

We analyzed treatment effects on the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) in patients with symptomatic LSS focused on our Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS) dataset from 2008 and 2009. Symptomatic LSS was assessed using a validated LSS diagnostic support tool (Konno et al. 2007). Exclusion criteria comprised a history of spinal surgery. The one-to-one nearest-neighbor propensity score matching technique was used between patients who did and did not receive conservative treatment. The potential confounders considered in the present study were age, gender, height, weight, smoking, difficulty in walking 100 meters, urinary incontinence during walking, comorbidities, and history of treatment for musculoskeletal diseases. None of the patients received public health intervention such as secondary health examinations throughout the observational period. The medical care that the patients received was recorded for one year.

RESULTS:

The baseline prevalence of symptomatic LSS was 376 (16.3%) of 2302 participants. Within the year of follow-up, eleven and 114 patients were treated by lumbar spinal surgery and conservatively, respectively (treated group), whereas 251 patients were not treated (untreated group). The conservative treatment group had a lower health-related quality of life than the untreated group at baseline and one-year follow-up. After propensity-matched analysis, the median change in mental health sub-scale score was significantly lower in the conservative treatment group than in the untreated group.

DISCUSSION:

The degree of LSS might be more severe among conservatively treated than untreated patients because their HR-QOL scores were lower than those of untreated patients at all observational periods. There was no apparent deterioration in the HR-QOL of untreated LSS patients within the one-year follow-up period, even when the patients were left to their natural medical consultation behaviors.

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