Quantification of Impairment in Patients with Lumbar Spinal Stenosis


Authors: B. Mičánková Adamová 1,2;  S. Voháňka 1,2
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  CEITEC – Středoevropský technologický institut, MU, Brno 2
Published in: Cesk Slov Neurol N 2013; 76/109(5): 570-574
Category: Review Article

Overview

Quantification of impairment in patients with lumbar spinal stenosis (LSS) should be based on assessment of the severity of clinical impairment and its impact on patient disability, rather than derived from a relative analysis of radiological findings. A range of scores and scales are used to assess patient status and there are several valid reasons why impairment should be quantified, including accurate assessment of patient status, evaluation of long-term clinical outcome and therapeutic efficacy, and help with the choice of optimal treatment modality. This article addresses the scales, questionnaires and quantified assessments that the authors often use in patients with LSS, namely a visual analogue scale for pain or a pain intensity numerical rating scale, the neurological impairment score in lumbar spinal stenosis, the Oswestry Disability Index and measuring of distance covered on a treadmill. We propose criteria for the assessment of LSS severity that may be useful in selecting a treatment (conservative or surgical therapy). These are based on the evaluation of pain using a pain intensity numerical rating scale, assessment of disability using the Oswestry Disability Index and analysis of distance covered on a treadmill.

Key words:
lumbar spinal stenosis – The Oswestry Disability Index – neurogenic claudication –pain assessment

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Postacchini F. Management of lumbar spinal stenosis. J Bone Joint Surg Br 1996; 78(1): 154– 164.

2. Epstein NE, Maldonado VC, Cusick JF. Symptomatic lumbar spinal stenosis. Surg Neurol 1998; 50(1): 3– 10.

3. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989; 10(4): 407– 415.

4. Hägg O, Fritzell P, Nordwall A. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 2003; 12(1): 12– 20.

5. Fritz JM, Delitto A, Welch WC, Erhard RE. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Arch Phys Med Rehabil 1998; 79(6): 700– 708.

6. Micankova Adamova B, Vohanka S, Hnojcikova M,Okacova I, Dusek L, Bednarik J. Neurological impairment score in lumbar spinal stenosis. Eur Spine J 2013; 22(8): 1897– 1906.

7. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981; 19(8): 787– 805.

8. Ware JE jr, Sherbourne CD. The MOS 36- item short‑ form health survey (SF‑ 36). I. Conceptual framework and item selection. Med Care 1992; 30(6): 473– 483.

9. Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 66(8): 271– 273.

10. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low‑ back pain. Spine 1983; 8(2): 141– 144.

11. Hägg O, Fritzell P, Romberg K, Nordwall A. The General Function Score: a useful tool for measurement of physical disability. Validity and reliability. Eur Spine J 2001; 10(3): 203– 210.

12. Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN. Measurement properties of a self‑ administered outcome measure in lumbar spinal stenosis. Spine 1996; 21(7): 796– 803.

13. Lassale B, Bitan F, Bex M, Deburge A. Functional results and prognostic factors in the surgical treatment of degenerative lumbar stenosis. Rev Chir Orthop Reparatrice Appar Mot 1988; 74 (Suppl 2): 85– 88.

14. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11- point numerical pain rating scale. Pain 2001; 94(2): 149– 158.

15. Paice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs 1997; 20(2): 88– 93.

16. Porter RW. Spinal stenosis and neurogenic claudication. Spine 1996; 21(17): 2046– 2052.

17. Deen HG jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Test‑ retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis. Mayo Clin Proc 2000; 75(10): 1002– 1007.

18. Deen HG jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome. J Neurosurg 1995; 83(1): 27– 30.

19. Deen HG, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Use of the exercise treadmill to measure baseline functional status and surgical outcome in patients with severe lumbar spinal stenosis. Spine 1998; 23(2): 244– 248.

20. Adamova B, Vohanka S, Dusek L. Differential dia­gnostics in patients with mild lumbar spinal stenosis: the contributions and limits of various tests. Eur Spine J 2003; 12(2): 190– 196.

21. Nagler W, Hausen HS. Conservative management of lumbar spinal stenosis. Identifying patients likely to do well without surgery. Postgrad Med 1998; 103(4): 69– 88.

22. Okoro T, Qureshi A, Sell B, Sell P. The accuracy of assessment of walking distance in the elective spinal outpatients setting. Eur Spine J 2010; 19(2): 279– 282.

23. Schulte TL, Schubert T, Winter C, Brandes M, Hackenberg L, Wassmann H et al. Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery. Eur Spine J 2010; 19(11): 1855– 1864.

24. Baker D, Pynsent P, Fairbank J. The Oswestry Disability Index revisited. In: Roland J, Jenner J (eds). Back pain: New Approaches to Rehabilitation and Education. Manchester, UK: Manchester University Press 1989: 174– 186.

25. Suarez‑ Almazor ME, Kendall C, Johnson JA, Skeith K, Vincent D. Use of health status measures in patients with low back pain in clinical settings. Comparison of specific, generic and preference‑based instruments. Rheumatology (Oxford) 2000; 39(7): 783– 790.

26. Taylor SJ, Taylor AE, Foy MA, Fogg AJ. Responsiveness of common outcome measures for patients with low back pain. Spine 1999; 24(17): 1805– 1812.

27. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25(22): 2940– 2953.

28. Mičánková Adamová B, Hnojčíková M, Voháňka S,Dušek L. Oswestry dotazník, verze 2.1a –  výsledky u pacientů s lumbální spinální stenózou, srovnání se starší verzí dotazníku. Cesk Slov Neurol N 2012; 75/ 108(4): 460– 467.

29. Mičánková Adamová B. Hodnotící škály a vyšetření na mechanickém chodníku. In: Mičánková Adamová B (ed). Lumbální spinální stenóza. 1st ed. Praha: Galén 2012: 45– 68.

30. North American Spine Society. Evidence Based Clinical Guidelines for Multidisciplinary Spine Care: Dia­gnosis and treatment of degenerative lumbar spinal stenosis (revised 2011) [on-line]. Available from URL: http:/ / www.spine.org/ Documents/ LumbarStenosis11.pdf.

31. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis: conservative or surgical management? A prospective 10‑year study. Spine 2000; 25(11): 1424– 1435.

32. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long‑term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 2005; 30(8): 936– 943.

33. Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J et al. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine 2007; 32(1): 1– 8.

34. Slätis P, Malmivaara A, Heliövaara M, Sainio P, Herno A, Kankare J et al. Long‑term results of surgery for lumbar spinal stenosis: a randomised controlled trial. Eur Spine J 2011; 20(7): 1174– 1181.

35. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 2008; 358(8): 794– 810.

36. Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four‑year results of the Spine Patient Outcomes Research Trial. Spine 2010; 35(14): 1329– 1338.

37. Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine 2011; 36(20): E1335– E1351.

38. Siebert E, Prüss H, Klingebiel R, Failli V, Einhäupl KM, Schwab JM. Lumbar spinal stenosis: syndrome, dia­gnostics and treatment. Nat Rev Neurol 2009; 5(7): 392– 403.

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Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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