Impact of knee osteoarthritis on surgical outcomes of lumbar spinal canal stenosis

View More View Less
  • 1 Keiyu Orthopedic Hospital, Gunma;
  • 2 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo;
  • 3 Department of Orthopaedic Surgery, Fujita Health University, Aichi;
  • 4 Department of Orthopaedic Surgery, Tokyo Medical Center, Tokyo; and
  • 5 Keio Spine Research Group (KSRG), Tokyo, Japan

OBJECTIVE

Lumbar spinal canal stenosis (LSS) and knee osteoarthritis (KOA), both of which are age-related degenerative diseases, are independently correlated with increased pain and dysfunction of the lower extremities. However, there have been few studies that investigated whether LSS patients with KOA exhibit poor clinical recovery following lumbar spinal surgery. The aim of this study was to elucidate the surgical outcomes of lumbar spinal surgery for LSS patients with KOA using multiple health-related quality of life (HRQOL) parameters.

METHODS

A total of 865 consecutive patients who underwent posterior lumbar spinal surgery for LSS were retrospectively reviewed. Baseline characteristics, radiographic parameters, perioperative factors, and multiple HRQOL parameters were analyzed preoperatively and at 1-year follow-up. HRQOL items included the Zurich Claudication Questionnaire, Oswestry Disability Index, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The effectiveness of surgical treatment was assessed using the JOABPEQ. The treatment was regarded as effective when it resulted in an increase in postoperative JOABPEQ score by ≥ 20 points compared with preoperative score or achievement of a postoperative score of ≥ 90 points in those with a preoperative score of < 90 points.

RESULTS

A total of 32 LSS patients with KOA were identified, and 128 age- and sex-matched LSS patients without KOA were selected as controls. In both groups, all HRQOL parameters markedly improved at the 1-year follow-up. On the SF-36, the postoperative mean score for the role physical domain was significantly lower in the KOA group than in the control group (p = 0.034). The treatment was significantly less “effective” in the social life domain of JOABPEQ in the KOA group than in the control group (p < 0.001).

CONCLUSIONS

The surgical outcomes of LSS patients with KOA are favorable, although poorer than those of LSS patients without KOA, particularly in terms of social life and activities. These results indicate that LSS patients with KOA experience difficulty in routine work or ordinary activities due to knee pain or restricted knee ROM even after lumbar spinal surgery. Hence, preoperative KOA status warrants consideration when planning lumbar spinal surgery and estimating surgical outcomes of LSS.

ABBREVIATIONS DDD = degenerative disc disease; DM = diabetes mellitus; HL = hyperlipidemia; HRQOL = health-related quality of life; HTN = hypertension; JOABPEQ = Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; KOA = knee osteoarthritis; LL = lumbar lordosis; LSS = lumbar spinal canal stenosis; ODI = Oswestry Disability Index; PI = pelvic incidence; PT = pelvic tilt; ROM = range of motion; SF-36 = Medical Outcomes Study 36-Item Short-Form Health Survey; SS = sacral slope; SVA = sagittal vertical axis; TK = thoracic kyphosis; TKR = total knee replacement; VAS = visual analog scale; ZCQ = Zurich Claudication Questionnaire.

Supplementary Materials

    • Supplementary Tables 1–3 (PDF 421 KB)

Contributor Notes

Correspondence Nobuyuki Fujita: Keio University School of Medicine, Tokyo, Japan. nfujita@a7.keio.jp.

INCLUDE WHEN CITING Published online December 27, 2019; DOI: 10.3171/2019.10.SPINE19886.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Metrics

All Time Past Year Past 30 Days
Abstract Views 131 131 131
Full Text Views 40 40 40
PDF Downloads 68 68 68
EPUB Downloads 0 0 0