Recovery outcomes for military personnel undergoing surgery for lumbar spinal stenosis induced by physical overload: a retrospective study

Abstract

Background

Servicemen are at high risk for musculoskeletal injuries, particularly lumbar spinal stenosis (LSS), due to the physical demands of combat and training. LSS often leads to significant disability, impacting soldiers’ quality of life and operational readiness. Surgical intervention is frequently needed, but the optimal technique for military patients remains debated. This study aimed to evaluate the outcomes of different surgical approaches for treating LSS, unilateral laminectomy for bilateral decompression (ULBD), open decompression, and decompression laminectomy with transpedicular stabilization, in wounded Ukrainian military personnel, focusing on pain relief, functional recovery, and rehabilitation timelines.

Methods

Sixty-four male servicemen (43 ± 4 years) with LSS were divided into three groups according to the surgery type: the servicemen with LSS were divided into three groups according to the surgery type: Group 1 (ULBD), Group 2 (open decompression), and Group 3 (decompression with transpedicular stabilization). Preoperative and postoperative assessments included pain intensity (Visual Analog Scale), quality of life and disability (Oswestry Disability Index), and functional recovery using the International Classification of Functioning, Disability, and Health. Follow-up evaluations were conducted at one week, one month, and six months postsurgery.

Results

Postoperative outcomes revealed significant pain reduction across all groups. However, Group 3 patients exhibited slower recovery, with persistent moderate impairments in quality of life and mobility six months postsurgery. In contrast, Groups 1 and 2 demonstrated faster rehabilitation, with minimal impairments by six months. The time to return to duty was notably longer in Group 3 (80.8 ± 20.8 days) than in Group 1 (27.4 ± 15.3 days) and Group 2 (38.4 ± 16.6 days).

Conclusions

ULBD and open decompression techniques offer faster recovery and better functional outcomes for military personnel with LSS compared to decompression with transpedicular stabilization. These findings suggest that less invasive procedures may be more suitable for military patients requiring a swift return to duty.

Background

The professional demands of military personnel are characterized by extreme physical exertion and prolonged performance of high-impact tasks. These challenges significantly increase the risk of musculoskeletal injuries [1, 2]. A review of the work of the US Navy Physical Assessment Board over a one-year period revealed that musculoskeletal disorders were the most common medical issues among servicemen, accounting for 43% of cases, with low back pain being the most prevalent at 29%. Specific risk factors for military personnel include constant physical strain from wearing bullet-proof vests and carrying ammunition, psychological trauma, exposure to extreme shock and vibration, heavy combat loads, and injuries sustained during airborne, air assault, and ground operations in urban environments [3, 4]. In addition to injuries, low back pain is a leading cause of combat unit exhaustion and disability among servicemen, often resulting in a low rate of return to active duty. Notably, the incidence of low back pain is the lowest among younger soldiers, and it increases with age [3, 4]. One severe outcome of such musculoskeletal strain is degenerative lumbar spinal stenosis (LSS), a condition closely associated with hypertrophy and osteophyte formation in intervertebral joints [5, 6]. Overload and micro-trauma leading to hypertrophy of the spinal joints significantly contribute to narrowing of the spinal canal [7]. Furthermore, degeneration of the intervertebral joints results in spinal instability, spondylolisthesis, and impaired mobility [6–8]. Evidence from U.S. and international armed forces shows that surgical treatment of lumbar spinal stenosis and related degenerative conditions can substantially influence recovery timelines and return‑to‑duty rates, with minimally invasive decompression techniques generally associated with faster rehabilitation and earlier resumption of military tasks [1–4]. These findings underscore the importance of selecting surgical approaches that balance clinical effectiveness with the need for rapid functional recovery in active‑duty personnel.

Conservative treatment for lumbar spinal stenosis is effective only in the early stages of the disease [9]. In contrast, surgical intervention becomes necessary in later stages or for patients who do not respond to conservative measures. Traditional laminectomy, as well as less invasive procedures such as unilateral laminectomy for bilateral decompression (ULBD) and decompression laminectomy with transpedicular stabilization, are among the most common surgical strategies for treating LSS [10, 11]. The severity of the disease and surgical risks, such as infection, hemorrhage, nerve injury, or dura mater injury, largely determine the choice of treatment strategy. However, the efficacy and safety of various surgical approaches for treating LSS remain subjects of ongoing debate [10–18].

The purpose of this study was to evaluate the impact of surgical treatment for lumbar spinal stenosis induced by excessive physical loads on the recovery process of middle-aged military personnel from the Armed Forces of Ukraine, using clinical pain assessment, functional disability questionnaires, and radiological evaluation of spinal canal decompression. The study evaluated recovery after different surgical methods (open decompression, ULBD, and decompression laminectomy with transpedicular stabilization techniques, including transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF)) at short postoperative period of time: one week, one month, and six months postsurgery.

Methods

Study design and participants

This single-center retrospective study involved 64 servicemen who underwent surgical intervention for lumbar spinal canal stenosis at the Spine Surgery Department of the Spinal (Neurosurgical) Centre, SI “Institute of Traumatology and Orthopedics” in Kyiv NAMS of Ukraine,” between 2023 and 2024. The study was conducted in accordance with the Local Ethics Committee of the Institute and performed in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants prior to their inclusion in the research. The study was conducted in accordance with STROBE guidelines.

The cohort consisted of men with a mean age of 43 ± 4 years and an average BMI of 22.9 ± 1.6. Inclusion criteria: patients were eligible for the study if they were active‑duty servicemen of the Armed Forces of Ukraine with MRI‑confirmed lumbar spinal canal stenosis, accompanied by neurological symptoms consistent with the condition, including radiculopathy and/or neurogenic intermittent claudication. Only individuals who had undergone an adequate course of conservative treatment without clinical improvement were considered for surgical intervention and inclusion in the study. Exclusion criteria: Patients were excluded if they had neurological disorders unrelated to lumbar spinal stenosis that could confound postoperative functional assessment. These conditions included peripheral polyneuropathy and traumatic nerve injuries of the lower extremities (e.g., gunshot‑related nerve damage), confirmed by electroneuromyography (ENMG). Individuals with such conditions were excluded to ensure that postoperative outcomes reflected the effects of spinal decompression rather than unrelated neurological deficits. All patients treated during the study period were male servicemen; no female patients meeting the inclusion criteria presented for surgical treatment. Out of 98 individuals who underwent surgical treatment for lumbar spinal stenosis, 64 met the established inclusion criteria. Postoperative treatment strategies included the prevention of postoperative swelling and scar formation, as well as wearing an orthosis for 21 days and performing therapeutic exercises.

As this was a retrospective study, no randomization was performed. The choice of surgical procedure (ULBD, open decompression, or decompression with transpedicular stabilization) was made individually for each patient based on preoperative MRI findings and the severity of degenerative changes, including facet joint hypertrophy, spondyloarthrosis, and segmental instability. Additional factors considered in the decision-making process included sagittal alignment and the anticipated postoperative mechanical load associated with active military service. In selected cases, decompression with transpedicular stabilization was extended to adjacent levels to reduce the risk of postoperative instability or adjacent segment degeneration, particularly in patients exposed to sustained high physical demands. Thus, surgical allocation reflected clinical indications rather than random assignment.

In cases where adequate decompression required facet resection exceeding 50%, the risk of iatrogenic instability was considered clinically significant. While such risk may be acceptable in low‑demand civilian populations, it is substantially amplified in active‑duty servicemen who routinely carry loads ≥ 35 kg and are exposed to repetitive high‑impact activities.

Fusion was therefore indicated only when these structural or biomechanical factors were present, including: (1) radiographic segmental instability on flexion–extension views; (2) advanced facet joint degeneration or spondyloarthrosis; (3) severe foraminal stenosis requiring extensive facet removal; (4) adjacent‑segment degeneration increasing the likelihood of postoperative mechanical failure; and (5) sagittal imbalance not correctable with decompression alone. In such cases, transpedicular stabilization was selected to ensure durable postoperative stability under military occupational demands.

The participants were divided into three groups based on the type of surgery they underwent:

• Group 1 (n = 21): Patients in this group underwent endoscopic decompression (ULBD) at various levels: L3–L4 (n = 7), L4–L5 (n = 12), and L5–S1 (n = 2).

• Group 2 (n = 19): Patients in this group underwent open decompression at the levels of L3–L4 (n = 6), L4–L5 (n = 5), and L5–S1 (n = 8).

• Group 3 (n = 24): Patients in this group underwent decompression laminectomy with transpedicular stabilization at the levels of L4–L5 (n = 4), L5–S1 (n = 4), L3–L4–L5 (n = 3), and L4–L5–S1 (n = 3). This group also included 6 patients with interbody cage placement: PLIF L4–L5 (n = 3), L5–S1 (n = 2), TLIF L4–L5 (n = 3), L5–S1 (n = 2).

Measurements and assessments

The cross-sectional area of the spinal canal was measured using T2 MR images at the level of the middle of the disc in the affected segment via the Radiant Dicom software for Windows. Examples of pre- and postoperative MRI scans for the different groups are shown in Fig. 1. Decompression results were assessed using pre- and postoperative MRI (1 day after surgery).

Fig. 1.

Examples of pre- and postoperative MRI scans of the spinal canal for various surgical cases. Cross-sectional images were obtained using the Radiant Dicom Viewer program. A, B Views before and after UBLD, respectively. C, D Views before and after open decompression, respectively. E, F Views before and after decompression laminectomy with transpedicular stabilization, respectively. In the fusion case, multilevel stabilization was performed due to radiographic evidence of adjacent‑segment degeneration and biomechanical considerations, including sagittal balance and the anticipated high postoperative physical load associated with active military service. Extending the fusion construct was indicated to ensure adequate long‑term stability. Lines (in yellow) indicate the areas of surgical intervention

The severity of the pain syndrome was assessed using a visual analog pain scale (VAS, cm), and patient satisfaction and quality of life were assessed using the Oswestry low back pain disability questionnaire (ODI). The Oswestry Questionnaire (version 2.0) [19] allowed us to determine the level of impairment of patients’ quality of life in terms of points and the JoSw disability index: 0% to 20% as minimal; 20% to 40% as moderate; 40% to 60% as significant; 60% to 80% as leading to disability; 80% to 100% as bedridden or as simulated symptoms. VAS pain intensity was evaluated at four time points: preoperatively, and at 7 days, 1 month, and 6 months after surgery. Functional status was assessed using the ODI before surgery and at 1 and 6 months postoperatively.

Additionally, a survey using the International Classification of Functioning, Disability, and Health (ICF) was conducted among the operated soldiers to assess the early rehabilitation process and their ability to perform daily and professional activities. The survey focused on the following criteria:

• Patient verticalization postsurgery (domain d410, changing body position);

• Walking ability and distance postsurgery (domain d450, walking and moving);

• Ability and duration of sitting postsurgery (domain d4153, sitting position);

• Activity limitations (restricted movements and actions) (domain d430-d449, moving, handling objects, d9201, sports activities).

Statistical analysis

The data were analyzed using two-way ANOVA with repeated measures, and the results are graphically presented. The mean values ± SD were compared across different time points: before surgery, 1 day after surgery, 1 month after surgery, and 6 months after surgery for the VAS score; before surgery, 1 month after surgery, and 6 months after surgery for the ODI score; and for the ICF criterion during the postoperative period. The analysis considered two factors: participant groups and time. A Bonferroni post hoc analysis was also conducted to determine differences among the groups, with significance set at p < 0.05. The Shapiro‒Wilk test was used to assess the normality of the data distribution, with a p value > 0.05 indicating no evidence of nonnormality. The data analysis was performed using the software “Statistica 8.0” (StatSoft, Inc.).

The study size of 64 participants was determined based on a moderate effect size expectation (0.4) to achieve a desired statistical power of 0.80 in a two-way ANOVA with repeated measures. This size was sufficient to detect meaningful differences in outcomes (pain reduction, functional recovery, and return-to-duty time) across the three surgical groups.

Results

Preoperative assessment

The severity of back pain and lower limb(s) pain reported by the servicemen during the preoperative period ranged from 4 to 8 cm for back pain, with averages of 5.3 ± 1.3 cm (95% CI [4.71, 5.89]), 5.8 ± 1.4 cm (95% CI [5.13, 6.47]), and 5.5 ± 1.1 (95% CI [5.04, 5.96]) cm in the first, second, and third groups, respectively (Fig. 2). For lower limb pain, the scores ranged from 3 to 7 points, with corresponding averages of 4.7 ± 1.1 (95% CI [4.20, 5.20]) cm, 5.1 ± 1.2 (95% CI [4.52, 5.68]) cm, and 5.2 ± 1.3 (95% CI [4.65, 5.75]) cm across the three groups (Fig. 3). The substantial overlap of confidence intervals indicates comparable baseline pain intensity and no clinically meaningful preoperative differences between groups. Moreover, no relevant differences in quality of life or self-care ability were detected between groups according to the ODI during the preoperative period, with mean values of 52.7 ± 19.8 (95% CI [43.7, 61.7]), 57.9 ± 15.4 (95% CI [50.5, 65.3]) and 51.2 ± 16.6, (95% CI [44.2, 58.2]), for groups 1–3, respectively) (Fig. 4).

Fig. 2.

Dynamics of back pain syndrome in servicemen according to the visual analog scale (cm) before and 7 days, 1 month and 6 months after surgery. Gr. 1, 2, and 3 – patients in groups 1, 2 and 3, respectively. The asterisks (*) that are placed on the columns indicate a significant difference between pre- and postsurgical values among the different groups (p < 0.05). The asterisks on the arrows indicate a significant difference between the values of group 3 and the other postsurgery groups (p < 0.05). The # symbol represents the difference between groups at different postsurgery periods, p < 0.05. The symbol (+) denotes the difference between the postsurgery periods of group 2 (p < 0.05)

Fig. 3.

Dynamics of lower extremity pain syndrome in servicemen according to the visual analog scale (cm) before and 7 days, 1 month and 6 months after surgery. The designations in this figure correspond to those in Fig. 2

Fig. 4.

Assessment of quality of life and self-care ability using the Oswestry Disability Index before surgery and 1 and 6 months after surgery. The designations in this figure correspond to those in Fig. 2

Postoperative VAS pain assessment

Pain decreased in all groups after surgery. Early back pain scores dropped significantly to 1.4 ± 0.6 (95% CI [1.13, 1.67]) cm (group 1, p < 0.00.1 vs. pre) and 2.1 ± 0.7 cm (95% CI [1.91, 2.29]) (group 2, p < 0.00.1 vs. pre), while group 3 showed a more modest reduction to 4.1 ± 0.7 cm (95% CI [3.77, 4.43]) (p = 0.07 vs. pre). After 1 month, late postoperative back pain averaged 1.1 ± 0.3 cm (95% CI [0.97, 1.23]) (group 1), 0.9 ± 0.4 cm (95% CI [0.71, 1.09]) (group 2), and 2.1 ± 0.9 cm (95% CI [1.81, 2.39]) (group 3, p < 0.001 vs. pre, Fig. 2). By 6 months, pain levels converged, with scores of 0.5 ± 0.3 (95% CI [0.37, 0.63]) cm, 0.6 ± 0.4 (95% CI [0.41, 0.79]) cm, and 1.2 ± 0.9 (95% CI [0.82, 1.58]) cm for groups 1–3, respectively. Two-way repeated measures ANOVA for back pain revealed a significant main effect of Time (F(3,183) = 114.2, p < 0.001, η_p² = 0.65), a non-significant main effect of Group (F(2,61) = 1.06, p = 0.35, η_p² = 0.04), and a significant Group × Time interaction (F(6,183) = 8.6, p < 0.001, η_p² = 0.22), indicating similar baseline pain but different recovery trajectories across groups.

Leg pain followed similar trends (Fig. 3). Early reductions to 2.3 ± 1.0 (95% CI [1.85, 2.75]) cm (group 1, p < 0.05), 1.1 ± 0.9 (95% CI [0.67, 1.53]) cm (group 2, p < 0.001 vs. pre), and 3.2 ± 1.1 (95% CI [2.74, 3.66]) cm (group 3, p = 0.09 vs. pre) were noted, with further improvements after 1 month. Late postoperative leg pain scores were 0.9 ± 0.7 (95% CI [0.59, 1.29]) cm (group 1), 1.1 ± 0.3 (95% CI [0.96, 1.24]) cm (group 2), and 2.2 ± 1.3 (95% CI [1.66, 2.74]) cm (group 3, p < 0.001 vs. pre). At 6 months, scores were 1.1 ± 0.4 (95% CI [0.92, 1.28]) cm, 1.2 ± 0.3 (95% CI [1.06, 1.34]) cm, and 1.4 ± 0.9 (95% CI [1.02, 1.78]) cm, respectively (p < 0.001 compared to preoperative data). For leg pain, two-way RM ANOVA similarly showed a significant main effect of Time (F(3,183) = 91.4, p < 0.001, η_p² = 0.60), non-significant main effect of Group (F(2,61) = 1.30, p = 0.28, η_p² = 0.05), and significant Group × Time interaction (F(6,183) = 7.6, p < 0.001, η_p² = 0.20).

Postoperative ODI

The assessment of quality of life and self-care ability using the ODI showed significant improvement in patients in the first and second groups 1 month after surgery compared to their preoperative condition (Fig. 4).

Before surgery, the ODI was similar across the first and second groups, with values of 52.7 ± 19.8% (95% CI [43.85, 61.55]) and 57.9 ± 15.4% (95% CI [50.49, 65.31]), respectively (p = 0.41). However, at just one month postsurgery, these scores significantly improved, dropping to 21.4 ± 8.5% (95% CI [17.50, 25.30]) in the first group and 19.1 ± 5.3% (95% CI [16.53, 21.67]) in the second group, reflecting a satisfactory quality of life and positive outcomes (p < 0.001) compared to the preoperative data. In contrast, the third group (those treated with decompression and stabilization) showed no significant changes one month after surgery, with scores decreasing from 51.2 ± 16.6% (95% CI [44.24, 58.16]) to 40.2 ± 9.4% (95% CI [36.26, 44.14]) (p = 0.12), indicating that most patients in this group still experienced significant impairments in self-care and daily activities.

Six months after surgery, the ODI score was 10.7 ± 5.4% (95% CI [8.24, 13.16]) in the first group and 15.0 ± 4.1% (95% CI [13.02, 16.98]) in the second group (p < 0.001), indicating minimal impairment that did not interfere with daily activities or military duties. However, in the third group, moderate impairments persisted, with an ODI of 20.3 ± 8.1% (95% CI [16.90, 23.70]) (p = 0.06), suggesting that those in the transpedicular stabilization group required further rehabilitation and monitoring.

Two-way RM ANOVA for ODI showed a significant main effect of Time (F(2,122) = 142.3, p < 0.001, η_p² = 0.70), non-significant main effect of Group (F(2,61) = 0.49, p = 0.62, η_p² = 0.03), and a significant Group × Time interaction (F(4,122) = 10.2, p < 0.001, η_p² = 0.25), confirming differential recovery patterns.

ICF evaluation

The survey results in the early postoperative period revealed the following differences: patient verticalization in the first group occurred on average 6.2 ± 2.9 h after surgery; in the second group, it occurred after 10.7 ± 4.4 h; and in the third group, with transpedicular stabilization, verticalization without complications according to the patient’s capabilities occurred on average 20.4 ± 5.7 h postsurgery (p < 0.001).

The ability to sit during the first week postsurgery was limited in the second group (0–15 min) and in the third group (0–15 min). In the first group, the sitting time was extended to 20–65 min, which is associated with minimal tissue trauma during surgical access (Table 1).

Table 1.

Function limitations and activity (according to the ICF) after endoscopic, open and stabilization surgical interventions in servicemen with lumbar spinal stenosis

ICF domain	Characteristics	1group	2 group	3 group
d410	Verticalization technique	over the stomach / over the side	over the stomach / over the side	over the stomach / over the side
d410	Verticalization after surgery (number of hours after surgery)	6.2 ± 2.9	10.7 ± 4.4	20.4 ± 5.7
d4153	Ability to sit after surgery during the day,	Yes,	Not recommended	No,
	duration min.	20–65	0–15	0–15
	After 1 month min.	No restrictions	No restrictions	Up to 2 h
d450	Walking distance after surgery
	After 1 week (m)	738.7 ± 186.2	500 ± 145.5	283 ± 123.4
	After 1 month (m)	1950 ± 302.6	1840 ± 321.5	902.5 ± 100.6
	After 6 months (m)	5590 ± 702.3	4900.7 ± 598.9	2040.7 ± 409.5
е 110	Wearing a corset	Yes	Yes	If required
d9201	Prohibited movements: bending, jumping, carrying heavy loads	Within 1–2 months	Within 1–2 months	Within 2–3 months
d859	Time when you can return to exercises (day)	The day after surgery	After 2–3 days	After 3–7 days
d859	Return to professional duties, days	27.4 ± 15.3	38.4 ± 16.6	80.8 ± 20.8

Quantitative data are presented as mean ± Standard Deviation

The following was used to determine the postoperative walking distance:

One month after surgery, the average walking distance among patients in the first group was 738.7 ± 186.2 m (95% CI [655.5, 821.9]); in the second group, it was 500 ± 145.5 m (95% CI [430.0, 570.0]); and in the third group, the distance that patients could walk in the early postoperative period was almost half that, 283 ± 123.4 m (95% CI [231.1, 334.9]) (p < 0.001), compared to the results of the first and second groups.

Six months postsurgery, limitations in the ability to walk long distances persisted in the third group (2040.7 ± 409.5 m, 95% CI [1868.8, 2212.6])). The results for the first group (5590 ± 702.3 m, 95% CI [5270.7, 5909.3]) and the second group (4900.7 ± 598.9 m, 95% CI [4612.7, 5188.7]) did not significantly differ (p = 0.21) and were almost three times greater than the results for the transpedicular stabilization group (Table 1).

Return to duty

A survey of military personnel regarding their return to professional duties during long-term follow-up showed that servicemen returned to work after an average of 27.4 ± 15.3 days in the first group and 38.4 ± 16.6 days in the second group, whereas return to work was substantially delayed in the third group with transpedicular stabilization (80.8 ± 20.8 days) (Table 1). Patients in the endoscopic and open decompression groups returned to full military duty without restrictions, with earlier return observed in the endoscopic group. In contrast, patients who underwent decompression with transpedicular stabilization required longer rehabilitation, and several returned to duty with activity restrictions at the 6-month follow-up.

Discussion

The results of this study describe the varying outcomes of different surgical interventions for LSS in wounded servicemen, emphasizing the need for a tailored approach to surgical treatment depending on the severity of the condition and the specific needs of the patient.

The most pronounced early postoperative pain relief was observed in patients who underwent ULBD and open decompression, which aligns with the findings of previous research indicating that minimally invasive techniques generally offer faster pain relief and recovery [10, 11, 20, 21]. The relatively greater pain levels in the group that underwent decompression laminectomy with transpedicular stabilization suggest that this more invasive approach, while necessary for patients with more severe or complex cases, results in a more prolonged and painful recovery period [12, 13].

The assessment of functional outcomes using the ODI provides a clear indication of the impact of surgical intervention on the quality of life and self-care abilities of patients. The first and second groups, which underwent ULBD and open decompression, respectively, showed substantial improvements in ODI scores within one month postsurgery, reflecting a return to near-normal function and minimal impairment in daily activities. It is likely that this improvement suggests that less invasive procedures generally allow for quicker functional recovery and better quality-of-life outcomes [14, 15, 22, 23].

In contrast, the third group, which underwent decompression laminectomy with stabilization, exhibited only modest improvements in ODI scores one month postsurgery, with moderate impairments persisting at the six-month follow-up. These findings suggest that while transpedicular stabilization is effective at stabilizing the spine and preventing further degeneration, it may require a longer rehabilitation period to achieve functional outcomes comparable to those of less invasive procedures [16, 17, 23].

The ability of servicemen to return to active duty was a critical outcome measure in this study. The rapid return to work observed in the first group (average of 27.4 days) compared to the second (38.4 days) and third groups (80.8 days) highlights the benefits of minimally invasive surgery in reducing downtime and allowing quicker reintegration into professional roles. This is particularly important in military settings where operational readiness and the ability to quickly return to duty are paramount. The extended recovery period required for those undergoing transpedicular stabilization underscores the need for careful patient selection and counseling regarding the expected recovery timeline and potential delays in returning to active duty [17, 18, 24].

For patients with mild to moderate stenosis, less invasive techniques such as ULBD may be preferred due to their association with quicker recovery and less postoperative pain [25]. Conversely, for patients with severe or complex stenosis, where spinal instability is a concern, more invasive techniques, such as decompression laminectomy with stabilization, may be necessary, although these patients are likely to require a longer recovery period. Given the specific occupational demands, there is concern that less invasive decompression techniques could present stability challenges over time. Studies indicate that while techniques like ULBD reduce immediate recovery time, they may not address the mechanical stresses of high-intensity activities, potentially leading to instability or degeneration [26]. Future research focusing on biomechanical evaluations post-surgery could help validate these approaches for military use.

The findings of the study have important implications for surgical decision-making in military settings. Given the significant differences in pain, functional recovery, and time to return to duty among the three groups, the choice of surgical technique should be guided by the severity of LSS, the overall health of the patient, and the specific functional requirements of military service. Additionally, the literature on rehabilitation suggests that early, structured physical therapy focusing on core stability and mobility can significantly accelerate return-to-duty timelines [27]. Integrating these findings may serve as a practical extension of our study’s findings.

Study limitations

Although this study provides insights into the outcomes of different surgical interventions for LSS in military personnel, it has several limitations. The sample size was relatively small, and the study was conducted at a single center, which may limit the generalizability of the findings. Additionally, the study did not account for long-term outcomes beyond six months, which are critical for understanding the durability of surgical benefits and the potential for recurrent symptoms or complications. Future research should include larger, multicenter studies with longer follow-up periods to validate these findings and provide more comprehensive guidance for clinical practice.

Conclusions

In conclusion, this study underscores the importance of individualized surgical planning for wounded servicemen with lumbar spinal canal stenosis. While minimally invasive procedures such as ULBD offer significant advantages in terms of pain relief and quicker return to duty, more invasive techniques such as decompression laminectomy with stabilization remain essential for patients with severe or complex conditions, despite their longer recovery times. These findings contribute to the ongoing discussion about optimizing surgical strategies for LSS, particularly in the context of military medicine, where the balance between effective treatment and rapid return to operational readiness is crucial.

Abbreviations

BMI

Body mass index

ICF

International Classification of Functioning, Disability, and Health

LSS

Lumbar spinal stenosis

ODI

Oswestry Disability Index

PLIF

Posterior lumbar interbody fusion

TLIF

Transforaminal lumbar interbody fusion

ULBD

Unilateral laminectomy for bilateral decompression

VAS

Visual Analogue Scale

Authors’ contributions

VM, LK and IF participated in the design and investigation of this study. VM and LK participated in data acquisition and collection. DN, AM, TA and IS analyzed the data. DN and AM drafted the manuscript. AM was a major contributor in writing the manuscript. IS was involved in funding acquisition. All authors read and approved the final manuscript.

Funding

This publication was prepared without any external source of funding.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Local Ethics Committee of the Spine Surgery Department of the Spinal (Neurosurgical) Centre, SI “Institute of Traumatology and Orthopedics” in Kyiv NAMS of Ukraine,” and performed in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants prior to their inclusion in the research.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.