TY - JOUR
T1 - Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain
AU - Haig, Andrew J.
AU - Tong, Henry C.
AU - Yamakawa, Karen S.J.
AU - Parres, Christopher
AU - Quint, Douglas J.
AU - Chiodo, Anthony
AU - Miner, Jennifer A.
AU - Phalke, Vaishali C.
AU - Hoff, Julian T.
AU - Geisser, Michael E.
PY - 2006/12
Y1 - 2006/12
N2 - STUDY DESIGN. Longitudinal masked, double-controlled cohort study. OBJECTIVES. To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA. The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS. Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS. Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION. Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.
AB - STUDY DESIGN. Longitudinal masked, double-controlled cohort study. OBJECTIVES. To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA. The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS. Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS. Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION. Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.
KW - Back pain
KW - Electromyography
KW - Magnetic resonance imaging
KW - Prognosis
KW - Spinal stenosis
UR - http://www.scopus.com/inward/record.url?scp=33845359904&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33845359904&partnerID=8YFLogxK
U2 - 10.1097/01.brs.0000247791.97032.1e
DO - 10.1097/01.brs.0000247791.97032.1e
M3 - Article
C2 - 17139226
AN - SCOPUS:33845359904
SN - 0362-2436
VL - 31
SP - 2950
EP - 2957
JO - Spine
JF - Spine
IS - 25
ER -