Abstract
Objectives
Lumbar spinal stenosis is a frequent and disabling disease of the elderly. However, the impact of its surgery on the long term (≥5 years) postoperative results and quality of life has not yet been evaluated in our setting.
Methods
The study population consisted of 224 patients operated between 2010 and 2017 at the Yaounde Central Hospital and the Yaounde General Hospital, of whom 33 were evaluated. Long term postoperative results were defined as reoperations, indication for reoperation, time elapsed to reoperation and control-X ray findings. Quality of life (QOL) was evaluated using the Oswestry Disability Index (ODI) and Numerical Pain Rating Scale (NRS), and compared to reported preoperative values. The one-way analysis of variance and Kruskal–Wallis tests were used for associations between patient characteristics and quality of life outcomes.
Results
Participants had a mean age of 57.3 years. 21% of participants were reoperated at least once, two years later on average due to reappearance of their clinical pictures. QOL significantly improved from being crippled (mean ODI 67.5%) and having severe pain (mean NRS 8) before surgery, to moderate disability (mean ODI 34.4%, p < 0.01) and moderate pain (means NRS 4, p < 0.01) five years later. Having large family support was the only factor independently associated with improved ODI and NRS (p = 0.01).
Conclusion
Lumbar spinal stenosis surgery is still beneficial five years later. Large cohort studies need to be conducted in our setting.
Keywords: Lumbar spinal stenosis, Long term result, Surgery, Quality of life, Cameroon
1. Introduction
Lumbar spinal stenosis (LSS) is the narrowing of the lumbar spine vertebra in the areas of the central canal, lateral recesses or intervertebral foramina (neural foramina) resulting in nerve root impingement, most often due to degenerative changes.1,2 Prevalence estimates of degenerative LSS vary between 11 and 39% world-wide.3 Actually, 266 million individuals have degenerative spine disease each year, with low- and middle-income countries having 4 times as many cases as high income countries.4 Moreover, LSS is the most common reason for spinal surgery in individuals above 65 years and is a highly disabling condition with profound impacts on the quality of life of patients.5, 6, 7
Most symptomatic patients initially receive conservative treatment modalities. The standard of care when conservative management fails or in severe cases, is surgery.8,9 Owing to the fact that quality of life is an important indicator for assessing outcomes after surgery and rehabilitation, concerns have grown for evaluating LSS patients after surgery. Indeed, though surgery significantly improves quality of life compared to conservative management, studies have shown that the effects of surgery fade over time, being less effective beyond two years.10 Moreover, it has been shown that patients operated for LSS are 3.9 times likely to be reoperated at an adjacent level and reoperation rates vary from 11 to 15 %.11,12 Many studies abroad have evaluated the quality of life of patients after surgery for LSS both in short (1 year) and long term (5 years and above).6,7,13, 14, 15, 16, 17 In Africa, a plethora of studies have evaluated the epidemiological, clinical and therapeutic aspects of LSS.9,18, 19, 20, 21 Studies conducted in Cameroon and others sub Saharan African countries showed that LSS affects a younger population (40–60 years) compared to Western countries (65–70 years) and thus, incapacitates people who are still in the working population.9,18,20 To our knowledge, only one study in Africa, conducted in Cameroon, has evaluated the quality of life of patients operated for LSS one year after surgery. So there are lack of local data in this topic concerning long term results and quality of life after surgery.
We therefore sought to investigate the long-term postoperative results and quality of life of patients using standardized tools such as the Oswestry Disability Index and the numerical rating scale so as to better precise the indications and benefits of surgery. This is relevant in our setting taking in account that the population are relatively young and the cost of surgery is supported by the patient. Understand long term result after surgery and quality of life are helpful for a reasonable decision making.
2. Materials and method
2.1. Study population
The study population consisted of LSS patients operated from the 1st of January 2010 to the 31st of December 2017 at the Yaounde Central Hospital (YCH), and the Yaounde General Hospital (YGH). We included patients who gave their informed consent. We did not include patients from whom consent could not be obtained and excluded those with incomplete medical records.
2.2. Procedure
We screened the medical files and operating room registries of the YCH and the YGH from January to March 2023. Participants were then called in April 2023 to: explain the purpose, benefits and risks of the study and schedule onsite meetings. For participants who could come to the study sites, we administered questionnaires and performed a control X-ray of the lumbar spine to those who had received a fusion procedure during their initial surgeries. This was done from May to June 2023. The questionnaire was administered in French and English and comprised of four sections: sociodemographic profile, clinical and therapeutic profile, postoperative results and quality of life outcomes. Plain radiography was done at the Yaounde Emergency Centre (YEC). Participants who could not travel to the study sites were administered consent forms and questionnaires online and through phone calls. Usually in our department of neurosurgery, patients stay with a booklet where scheduled fellow up information's were consigned, since lack digitalization of medical file. The X-ray films were then sent online to the principal investigator.
3. Outcome measures
The surgical outcomes were the long-term postoperative results, which we defined as: reoperations, indication for reoperation, time elapsed to reoperation and control X-ray findings. Quality of life outcomes were evaluated using the Oswestry Disability Index version 2.122 and the Numerical Pain Rating Scale (0–10),23,24 and compared to patients’ reported preoperative values. The ODI is a ten-section pain questionnaire used to evaluate functional disability after surgery (Table 1).
Table 1.
Oswestry disability index interpretation.
| Score (%) | Interpretation |
|---|---|
| 0 to 19 | Minimal disability |
| 20 to 39 | Moderate disability |
| 40 to 59 | Severe disability |
| 60 to 79 | Crippled |
| 80 to 100 | Bed-bound or exaggerative patients |
3.1. Statistical analysis
The data collection form was coded with CSPro (Census Survey Processing) and analysis was conducted using R statistical software 4.2.3 (R Foundation for Statistical Computing, Vienna, Austria). Qualitative variables were expressed as frequencies and percentages, while quantitative variables were expressed as means and standard deviations or medians and interquartile ranges. The ODI response scores per section were reverse coded on a six-point Likert scale (from extremely dissatisfied to extremely satisfied) to better appreciate the changes for every section. The one-way analysis of variance and Kruskal–Wallis tests were used to check for associations between patient characteristics and quality of life outcomes. The paired-t test was used to analyze differences between the preoperative and current ODI and NRS. Multivariate linear regression was used to find factors independently associated with increased or decreased quality of life.
4. Results
Of the 224 patients operated between 2010 and 2017, we did not include 7 patients (3 participants died before 2023, 3 participants refused to participate and there was one duplicate file). For the remaining 217 patients: 166 patients could not be reached through phone calls, 18 medical records were absent (and were excluded), and 33 patients were effectively evaluated. The flow chart of participants is shown in Fig. 1.
Fig. 1.
Flow chart of participants.
4.1. Descriptive data
The mean age of participants was 57.3 ± 9 years, and the most represented age group was 50–60 years (42%, n = 14). The sex ratio of 1:5. Table 2, Table 4 show the sociodemographic profile of not reachable patients and participants. Seventy height percent (n = 26) of participants were obese with a mean BMI of 30.9 ± 5 kg/m2. The main comorbidities found were Knee/hip osteoarthritis (67%, n = 22) and hypertension (55%, n = 18). Low back pain (55%, n = 18) and neurogenic claudication (48%, n = 16) were the most frequent clinical presentations. Fifty-two percent (n = 17) of participants were diagnosed of LSS without instability and 63.6% (n = 21) were treated by standard laminectomy ± spondylodesis. Table 3, Table 5 show the clinical and radiological profile of patients not reachable and participants.
Table 2.
Sociodemographic profile of operated patients not reachable. N = 166.
| Characteristic | n (%) |
|---|---|
| Age | |
| 40–49 | 39 (23.49) |
| 50–59 | 67 (40.36) |
| 60–69 | 42 (25.30) |
| 70–79 | 18 (10.83) |
| Sex | |
| Female | 125 (75.30) |
| Male | 41 (24.70) |
| Level of education | |
| Primary | 56 (33.73) |
| Secondary | 57 (34.33) |
| University | 31 (18.67) |
| None | 21 (12.65) |
| Marital status | |
| Single | 13 (7.83) |
| Free-union | 16 (9.63) |
| Married | 111 (68.86) |
| Divorced | 9 (5.42) |
| Widow(er) | 17 (10.24) |
| Profession | |
| Housewife | 67 (40.36) |
| Civil worker | 39 (23.49) |
| Retired | 12 (7.22) |
| Farmer | 34 (20.48) |
| Others | 14 (8.43) |
| Number of children | |
| 0–1 | 9 (5.42) |
| 2–4 | 66 (39.76) |
| 5–9 | 91 (54.82) |
Table 4.
Sociodemographic profile of participants.
| Characteristic | n (%) |
|---|---|
| Age | |
| 40–49 | 8 (24.0) |
| 50–59 | 14 (42.0) |
| 60–69 | 9 (27.0) |
| 70–79 | 2 (6.1) |
| Sex | |
| Female | 27 (82.0) |
| Male | 6 (18.0) |
| Level of education | |
| Primary | 13 (39.0) |
| Secondary | 10 (30.0) |
| University | 7 (21.0) |
| None | 3 (9.1) |
| Marital status | |
| Single | 1 (3.0) |
| Free-union | 1 (3.0) |
| Married | 26 (79.0) |
| Divorced | 1 (3.0) |
| Widow(er) | 4 (12.0) |
| Profession | |
| Housewife | 13 (39.0) |
| Civil worker | 9 (27.0) |
| Retired | 3 (9.1) |
| Farmer | 2 (6.1) |
| Others | 8 (24.3) |
| Number of children | |
| 0–1 | 2 (6.1) |
| 2–4 | 11 (33.0) |
| 5–9 | 20 (61.0) |
Table 3.
Clinical and radiologic profile of patients not reachable N = 166.
| Characteristic | Value |
|---|---|
| Body Mass Index | 31.6 ± 9 kg/m2 |
| Comorbidities | 123 (74.10) |
| Osteoarthritis | 128 (77.11) |
| Hypertension | 92 (55.42) |
| Previous back surgery | 26 (15.66) |
| Diabetes | 32 (19.28) |
| HIV | 7 (4.21) |
| Clinical presentation | |
| Low back pain | 48 (28.92) |
| Neurogenic claudication | 148 (89.16) |
| Lower extremity weakness | 32 (19.28) |
| Bowel/bladder symptoms | 14 (8.43) |
| Diagnosis | |
| LSS without instability | 74 (44.58%) |
| LSS with spondylolisthesis | 92 (55.42%) |
| Levels of stenosis | |
| Two levels | 69 (41.57%) |
| Three levels | 81 (48.80%) |
| More than three levels | 16 (9.64%) |
Values are expressed as either the number (%) or the mean ± SD.
Table 5.
Clinical and therapeutic profile of participants.
| Characteristic | Value |
|---|---|
| Body Mass Index | 30.9 ± 9 kg/m2 |
| Comorbidities | 24 (72.7) |
| Osteoarthritis | 16 (67.0) |
| Hypertension | 13 (54.0) |
| Previous back surgery | 7 (29.0) |
| Diabetes | 2 (8.3) |
| HIV | 1 (4.9) |
| Clinical presentation | |
| Low back pain | 18 (55.0) |
| Neurogenic claudication | 16 (48.0) |
| Lower extremity weakness | 5 (15.0) |
| Bowel/bladder symptoms | 2 (6.1) |
| Diagnosis | |
| LSS without instability | 17 (52%) |
| LSS with spondylolisthesis | 16 (48%) |
| Levels of stenosis | |
| Two levels | 13 (39,40%) |
| Three levels | 16 (48.48%) |
| More than three levels | 4 (12.12%) |
4.2. Surgical outcomes
Seven participants had been reoperated at least once (reoperation rate = 21.2%) due to reappearance of their clinical picture. The median time lapse between the first surgery and a subsequent reoperation was 24 ± 60 months. Of the 17 control X-rays which were done, 76.5 % (n = 13) were normal. Other findings included: hardware fractures (11.8%, n = 2), adjacent segment disease (5.9%, n = 1) and pseudoarthrosis (5.9%, n = 1). Table 6, Table 7, Table 8, Table 9 show the surgical outcomes of participants.
Table 6.
Surgical outcomes of participants.
| Characteristic | Value |
|---|---|
| Reoperations | 7 (21.2) |
| Number of reoperations | |
| 1 | 5 (15.2) |
| 2 | 1 (3) |
| >2 | 1 (3) |
| Time elapsed to reoperation | 24 ± 60 months |
| Indication | |
| Reappearance of clinical picture | 6 (18.2) |
| Replacement/Removal of fusion materials | 1 (3) |
| Control X-ray findings | |
| Normal | 13 (76.5) |
| Hardware fractures | 2 (11.8) |
| Pseudarthrosis | 1 (5.9) |
| Adjacent segment disease | 1 (5.9) |
Values are expressed as either the number (%) or the median ± IQR.
Table 7.
Association between age, sex, body mass index, comorbidities, fusion and reoperation.
| Variable | Reoperation n (%) |
||
|---|---|---|---|
| Yes | No | p-value | |
| Age | 0.80 | ||
| 40–49 | 2 (25%) | 6 (75.0%) | |
| 50–59 | 3 (21.4%) | 11 (78.6%) | |
| 60–69 | 2 (22.2%) | 7 (77.8%) | |
| 70–79 | 0 (0.0%) | 2 (100%) | |
| Sex | 0.30 | ||
| Male | 0 (0.0%) | 6 (100.0%) | |
| Female | 7 (25.9%) | 20 (74.1%) | |
| Body Mass Index | 0.03a | ||
| Normal | 1 (20.0%) | 4 (80.0%) | |
| Overweight | 4 (57.1%) | 3 (42.9%) | |
| Obesity class I | 0 (0.0%) | 11 (100.0%) | |
| Obesity class II | 0 (0.0%) | 4 (100.0%) | |
| Obesity class III | 0 (0.0%) | 1 (100.0%) | |
| Comorbidities | |||
| Osteoarthritis | 2 (12.5%) | 14 (87.5%) | 0.02a |
| Hypertension | 5 (38.5%) | 8 (61.5%) | 0.39 |
| Previous back surgery | 5 (71.4%) | 2 (28.6%) | 0.01a |
| Diabetes | 0 (0.0%) | 2 (100.0%) | 0.99 |
| HIV | 0 (0.0%) | 1 (100.0%) | 0.99 |
| Arthrodesis | 0.99 | ||
| Yes | 5 (23.8%) | 16 (76.2%) | |
| No | 2 (16.7%) | 10 (83.3%) | |
Statistically significant.
Table 8.
Association between the sociodemographic profile and ODI.
| Characteristic |
Oswestry Disability Index |
||
|---|---|---|---|
| Variable | mean ± sd (%) | median ± IQR (%) | p-value |
| Age | 0.14 | ||
| 40–49 | 28.3 ± 11.5 | 30.4 ± 19.6 | 0.31 |
| 50–59 | 30.7 ± 13.3 | 28.5 ± 13.0 | 0.33 |
| 60–69 | 40.4 ± 20.1 | 42.2 ± 35.6 | 0.30 |
| 70–79 | 57.7 ± 6.2 | 57.7 ± 0.0 | 0.06 |
| Sex | |||
| Male | 35.7 ± 22.7 | 28.0 ± 41.7 | 0.82 |
| Female | 34.1 ± 15.0 | 33.3 ± 17.8 | / |
| Level of education | 0.32 | ||
| Primary | 30.8 ± 16.3 | 28.9 ± 17.8 | 0.31 |
| Secondary | 35.0 ± 17.1 | 30.7 ± 26.2 | 0.88 |
| University | 33.4 ± 15.2 | 34.0 ± 24.2 | 0.85 |
| None | 50.3 ± 11.1 | 48.9 ± 0.0 | 0.07 |
| Marital status | |||
| Married | 33.6 ± 14.7 | 29.5 ± 17.8 | 0.60 |
| Othersb | 37.3 ± 22.0 | 33.3 ± 44.2 | / |
| Profession | 0.23 | ||
| Housewife | 30.9 ± 13.0 | 30.0 ± 18.9 | 0.31 |
| Civil worker | 32.1 ± 13.9 | 33.3 ± 22.1 | 0.63 |
| Retired | 51.6 ± 20.7 | 60.0 ± 0.0 | 0.05 |
| Othersc | 36.3 ± 20.1 | 28.5 ± 35.7 | 0.70 |
| Number of children | 0.01a | ||
| 0–1 | 63.4 ± 4.7 | 63.4 ± 0.0 | 0.03a |
| 2–4 | 39.6 ± 14.2 | 34.0 ± 20.0 | 0.12a |
| 5–10 | 28.6 ± 14.0 | 27.4 ± 21.0 | 0.01a |
Statistically significant.
Single, free-union, divorced, widow (er).
Trader, seamstress, computer scientist.
Table 9.
Associations between clinical characteristics and Oswestry Disability Index.
| Characteristic |
Oswestry Disability Index |
||
|---|---|---|---|
| Variable | mean ± sd (%) | median ± IQR (%) | p-value |
| Body mass index | 0.15 | ||
| Normal | 49.6 ± 23.7 | 60.0 ± 32.7 | 0.09 |
| Overweight | 36.1 ± 18.2 | 28.9 ± 38.0 | 0.94 |
| Obesity class I | 33.3 ± 8.6 | 34.0 ± 10.0 | 0.99 |
| Obesity class II | 19.0 ± 8.2 | 19.0 ± 15.5 | 0.03* |
| Obesity class III | 41.4 ± 0.0 | 41.4 ± 0.0 | 0.50 |
| Comorbidities | 0.67 | ||
| Hypertension | 36.0 ± 16.4 | 33.3 ± 26.5 | 0.50 |
| Diabetes | 42.3 ± 34.6 | 42.3 ± 0.0 | 0.71 |
| Osteoarthritis | 33.7 ± 17.0 | 31.1 ± 27.6 | 0.95 |
| Previous back surgery | 46.8 ± 20.3 | 60.0 ± 33.3 | 0.04* |
| Clinical symptoms | |||
| Low back pain | 34.5 ± 17.5 | 29.5 ± 27.5 | 0.98 |
| Neurogenic claudication | 34.1 ± 14.6 | 34.0 ± 17.2 | 0.91 |
| Lower extremity weakness | 28.4 ± 13.7 | 34.0 ± 25.9 | 0.56 |
| Bowel/bladder symptoms | 52.3 ± 20.4 | 52.3 ± 0.0 | 0.13 |
| Diagnosis | |||
| LSS without instability | 36.7 ± 19.3 | 34.0 ± 38.8 | 0.42 |
| LSS with spondylolisthesis | 32.0 ± 12.3 | 29.5 ± 17.1 | / |
4.3. Quality of life outcomes
Before surgery, 45% (n = 15) of participants were crippled with a mean ODI of 67.5 ± 17.5%, and 93.9% (n = 31) had severe pain with a mean NRS of 8 ± 2. At the time of evaluation, 48.5 % (n = 16) of participants were moderately disabled and 48.5 % (n = 16) had moderate pain. This improvement was statistically significant (p < 0.01 for both ODI and NRS). There was an overall improvement in all sections of the ODI. The most altered sections of the ODI were lifting and standing while the least altered sections were sitting and sleeping (Fig. 2, Fig. 3). The ODI and NRS were not statistically different for patients who were operated five years ago compared to those who were operated more than five years ago (p = 0.75 and p = 0.10 respectively) (Fig. 4, Fig. 5). The median ODI of patients who underwent spondylodesis was lower (28.9 ± 20.0%) compared to patients who underwent laminectomy alone (38.0 ± 36.2%), but this difference was not statistically significant (p = 0.14) (Fig. 6). We conducted multivariate linear regression taking into account our most significant factors to control for confounding. We found out that the large family support (number of children) and age were statistically significant irrespective of confounding. Bivariate analysis showed that having many children (large family support) was significantly associated with decreased ODI (p = 0.01) while previous back surgery was significantly associated with an increased ODI (p = 0.04). Having many children was the only factor independently associated with decreased ODI (Table 10).
Fig. 2.
Gantt chart of preoperative Oswestry Disability Index. The numbers within circles are the average reverse coded response scores per section.
Fig. 3.
Gantt chart of current Oswestry Disability Index. The numbers within circles are the average reverse coded response scores per section.
Fig. 4.
ODI and time elapsed since the first intervention.
Fig. 5.
NRS and time elapsed since the first intervention.
Fig. 6.
ODI distribution with respect to spondylodesis
Table 10.
Multivariate regression and Oswestry Disability Index.
| Characteristic | B | Beta | p-value |
|---|---|---|---|
| Variable | |||
| Number of children | −15.9 | −0.6 | 0.001* |
| Age | 0.6 | 0.3 | 0.04* |
| Previous surgery | −3.5 | −0.2 | 0.37 |
5. Discussion
Lumbar spinal stenosis is a disabling condition and a frequently operated disease in neurosurgical departments. Prior to this study, the long-term postoperative results and the impact of surgery on quality of life at least five years since the first surgery had not yet been evaluated in Africa. Less than a quarter of patients were reoperated at least once two years later, and they had a moderate quality of life five years since the first surgery.
The mean age of 57 years at diagnosis was similar to previous studies conducted in Cameroon.9,18,20 This shows that LSS affects a younger age group in Africa compared to Western countries. There is limited knowledge to account for this disparity. It may be due to activities specific to African populations as well as genetic and environmental factors. Most participants were obese with females with osteoarthritis and hypertension. Indeed, increasing weights in turn increase load on the lumbar vertebrae thereby accelerating the degenerative processes and resulting in poorer quality of life outcomes. Hypertension has been speculated to occur through an indirect mechanism as LSS may be associated with peripheral vascular compromise to the cauda equina nerve roots.25
Most patients were operated by conventional laminectomy and spondylodesis. This was different from a previous study in Cameroon in 2010 in which all the patients had been operated by laminectomy alone due to lack of fusion materials.9 Thus, this highlights an improvement in neurosurgical care in our setting. Reoperation rates worldwide vary from 11 to 15% with a median time lapse of 3.4 years.12,26 Conventional laminectomy that is still performed in our setting as opposed to minimally invasive laminectomy which has been shown to have superior outcomes.27
The Oswestry disability index of these patients before surgery were similar to a previous study in Cameroon evaluating quality of life outcomes one year after surgery.20 The significant improvement five years later corroborates a 10-year cohort in Finland.17 The latter also revealed that quality of life outcomes were not significantly different at five and ten years since the first surgery. This complements previous literature. Though the effects of surgery over time may fade over time being least effective beyond two years,10 they may be maintained from five to ten years.
Though we did not find studies investigating the association between family support here represented by number of children and LSS outcomes, Cardoso et al. in 2016 reported better postoperative recovery after open cholecystectomy in patients who had increased family support. This can be explained by the fact that having many children may provide social support and give patients a sense of purpose thereby increasing their psychological well-being. On the other hand, previous back surgery may worsen disability due to the increased risk of adjacent segment degeneration.28
5.1. Limitation of the study
The small sample size mainly due to not reachable patients hinders its external validity and made it difficult to find significant associations. Electronic medical records still lag in Sub-Saharan Africa, but considerable efforts are being made to increase their adoption.29 Digital health records were established at our study sites in 2022. Thus, studies conducted after this date will likely not suffer from this limitation. Also, recall bias was encountered as patients had to report their preoperative quality of life outcomes, which was minimized by considering only the ODI sections that they were confident reporting about.
Since many patients live very far from the neurosurgical center, they keep a booklet were yearly fellow up is mentioned. To minimize this bias, we also consider this booklet even by phone. Besides when we compare the characteristics of patients that could not be reach there is no significate difference concerning sociodemographic, clinical and radiological profile. Despite these limitations, the present study shows that surgery maintains a moderate quality of life in the long term, and may therefore improve its perception among LSS patients.
6. Conclusion
LSS surgery maintains a moderate quality of life in the long term. Body mass index, past history of osteoarthritis, previous back surgery and large family support are factors to consider in the process of decision making for surgery. Prospective large cohort studies should be conducted in our setting to better analyses the impact of surgery on quality of life.
Ethical concerns
Ethical clearance was obtained from the Institutional Review Board from the Faculty of Medicine and Biomedical Sciences of the University of Yaounde I (IRB/FMBS-UYI). Administrative authorizations were obtained from the Yaounde Central Hospital, the Yaounde General Hospital, and the Yaounde Emergency Centre. Informed consent was obtained from participants.
Authors Contribution
Bello Figuim: Conceptualization, writing, editing of the manuscriptHaman Nassourou Oumarou and Ndome Toto orlande: critical revisions of the manuscriptCelestin Bilong Mbangtang: Literature review, data collection, analysis and writing of the manuscriptDjientcheu Vincent De Paul: supervision, validation and critical revisions of the manuscript.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Abbreviations
- BMI
Body Mass Index
- LSS
Lumbar spinal stenosis
- NRS
Numerical Rating Scale
- ODI
Oswestry Disability Index
- QOL
Quality of Life
- YCH
Yaounde Central Hospital
- YEC
Yaounde Emergency Centre
- YGH
Yaounde General Hospital
Contributor Information
Bello Figuim, Email: bellofiguim@gmail.com.
Oumarou Haman Nassarou, Email: haman06@yahoo.fr.
Celestin Bilong Mbangtang, Email: celestinbilong27@yahoo.fr.
Ndome Toto Ludvine, Email: orlyndome@gmail.com.
Vincent De Paul Djientcheu, Email: vincent_djientcheu@yahoo.com.
References
- 1.Andaloro A. Lumbar spinal stenosis. JAAPA. 2019;32:49. doi: 10.1097/01.JAA.0000569788.21941.ca. [DOI] [PubMed] [Google Scholar]
- 2.Wu L., Cruz R. StatPearls. StatPearls Publishing; 2022. Lumbar spinal stenosis.http://www.ncbi.nlm.nih.gov/books/NBK531493/ Accessed December 16, 2022. [PubMed] [Google Scholar]
- 3.Jensen R.K., Jensen T.S., Koes B., Hartvigsen J. Prevalence of lumbar spinal stenosis in general and clinical populations: a systematic review and meta-analysis. Eur Spine J. 2020;29:2143–2163. doi: 10.1007/s00586-020-06339-1. [DOI] [PubMed] [Google Scholar]
- 4.Ravindra V.M., Senglaub S.S., Rattani A., et al. Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Global Spine J. 2018;8:784–794. doi: 10.1177/2192568218770769. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Otani K., Kikuchi S., Yabuki S., et al. Lumbar spinal stenosis has a negative impact on quality of life compared with other comorbidities: an epidemiological cross-sectional study of 1862 community-dwelling individuals. Sci World J. 2013;2013 doi: 10.1155/2013/590652. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Lin E.Y., Chen P.Y., Tsai P.S., Lo W.C., Chiu H.Y. Trajectory of health-related quality of life and its determinants in patients who underwent lumbar spine surgery: a 1-year longitudinal study. Qual Life Res. 2018;27:2251–2259. doi: 10.1007/s11136-018-1888-2. [DOI] [PubMed] [Google Scholar]
- 7.Jolles B.M., Porchet F., Theumann N. Surgical treatment of lumbar spinal stenosis. J Bone Joint Surg Br. 2001;83:949–953. doi: 10.1302/0301-620x.83b7.11722. [DOI] [PubMed] [Google Scholar]
- 8.Genevay S., Atlas S.J. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010;24:253–265. doi: 10.1016/j.berh.2009.11.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Onambany B., Esiene A., Motah M., Bello F., Djientcheu V.P. Aspects épidémiologiques, cliniques et thérapeutique du canal lombaire étroit et de la hernie discale lombaire opérés dans les services de chirurgie de l’Hôpital Général de Douala (HGD) et de l’Hôpital d’Hévécam de Niété. Health Sci Dis. 2010;11 [Google Scholar]
- 10.Malmivaara A., Slätis P., Heliövaara M., et al. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine. 2007;32:1–8. doi: 10.1097/01.brs.0000251014.81875.6d. [DOI] [PubMed] [Google Scholar]
- 11.Cheung P.W.H., Fong H.K., Wong C.S., Cheung J.P.Y. The influence of developmental spinal stenosis on the risk of re-operation on an adjacent segment after decompression-only surgery for lumbar spinal stenosis. J Bone Joint. 2019;101:154–161. doi: 10.1302/0301-620X.101B2.BJJ-2018-1136.R2. [DOI] [PubMed] [Google Scholar]
- 12.Goel S.A., Modi H.N. Reoperations following lumbar spinal canal stenosis. Indian J Orthop. 2018;52:578–583. doi: 10.4103/ortho.IJOrtho_380_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Lubelski D., Feghali J., Nowacki A.S., et al. Patient-specific prediction model for clinical and quality-of-life outcomes after lumbar spine surgery. J Neurosurg Spine. 2021;34:580–588. doi: 10.3171/2020.8.SPINE20577. [DOI] [PubMed] [Google Scholar]
- 14.Caralopoulos I.N., Bui C.J. Minimally invasive laminectomy in spondylolisthetic lumbar stenosis. Ochsner J. 2014;14:38–43. [PMC free article] [PubMed] [Google Scholar]
- 15.Pennington Z., Alentado V.J., Lubelski D., et al. Quality of life changes after lumbar decompression in patients with tandem spinal stenosis. Clin Neurol Neurosurg. 2019;184 doi: 10.1016/j.clineuro.2019.105455. [DOI] [PubMed] [Google Scholar]
- 16.Jansson K., Németh G., Granath F., Jönsson B., Blomqvist P. Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis. J Bone Joint Surg Br. 2009;91:210–216. doi: 10.1302/0301-620X.91B2.21119. [DOI] [PubMed] [Google Scholar]
- 17.Tuomainen I., Aalto T., Pesonen J., et al. Unfolding the outcomes of surgical treatment of lumbar spinal stenosis—a prospective 5- and 10-year follow-up study. Eur Spine J. 2020;29:2231–2242. doi: 10.1007/s00586-020-06424-5. [DOI] [PubMed] [Google Scholar]
- 18.Djientcheu V.D.P., Njamnshi A.K., Singwe M.N., et al. Canal lombaire étroit : à propos de 102 cas à l’Hôpital Central de Yaoundé. Revue Africaine de Chirurgie et Spécialités. 2010;4 [Google Scholar]
- 19.Mvogo Minkala T.L., Ongolo-Zogo P., Kamga J.P., Medjo É Hell. Aspects radiologiques du canal lombaire étroit à Yaoundé. J Radiol. 2009;90:1466. [Google Scholar]
- 20.Bello F., Njami V.A., Bogne S.L., et al. Quality of life of patients operated for lumbar stenosis at the Yaoundé Central Hospital. Br J Neurosurg. 2020;34:62–65. doi: 10.1080/02688697.2019.1692784. [DOI] [PubMed] [Google Scholar]
- 21.Zogo P., Minkala L., Juimo A. Biometrie scanographique du canal rachidien lombaire de l’adulte Camerounais. J Afr Médicale. 2011;34:580–588. [Google Scholar]
- 22.Fairbank J.C.T., Pynsent P.B. The Oswestry disability index. Spine. 2000;25:2940–2953. doi: 10.1097/00007632-200011150-00017. [DOI] [PubMed] [Google Scholar]
- 23.Numeric Pain Rating Scale. Physiopedia. Accessed May 24, 2023. https://www.physio-pedia.com/Numeric_Pain_Rating_Scale.
- 24.Iohom G. In: Postoperative Pain Management. Shorten G., Carr D.B., Harmon D., Puig M.M., Browne J., editors. W.B. Saunders; 2006. Chapter 11 - clinical assessment of postoperative pain; pp. 102–108. [Google Scholar]
- 25.Binder D.K., Schmidt M.H., Weinstein P.R. Lumbar spinal stenosis. Semin Neurol. 2002;22:157–166. doi: 10.1055/s-2002-36539. [DOI] [PubMed] [Google Scholar]
- 26.Moayeri N., Rampersaud Y.R. Revision surgery following minimally invasive decompression for lumbar spinal stenosis with and without stable degenerative spondylolisthesis: a 5- to 15-year reoperation survival analysis. J Spine Neurosurg. 2021;36:385–391. doi: 10.3171/2021.6.SPINE2144. [DOI] [PubMed] [Google Scholar]
- 27.Phan K., Mobbs R.J. Minimally invasive versus open laminectomy for lumbar stenosis: a systematic review and meta-analysis. Spine. 2016;41:E91–E100. doi: 10.1097/BRS.0000000000001161. [DOI] [PubMed] [Google Scholar]
- 28.Nerland U.S., Jakola A.S., Giannadakis C., et al. The risk of getting worse: predictors of deterioration after decompressive surgery for lumbar spinal stenosis: a multicenter observational study. World Neurosurgery. 2015;84:1095–1102. doi: 10.1016/j.wneu.2015.05.055. [DOI] [PubMed] [Google Scholar]
- 29.Odekunle F.F., Odekunle R.O., Shankar S. Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region. Int J Health Sci. 2017;11:59–64. [PMC free article] [PubMed] [Google Scholar]