Clinical Features of Older Patients with Lumbar Spinal Stenosis Who Discontinued Postoperative Follow-Up.

Abstract

Introduction: Although follow-up is recommended for 2 years after lumbar spinal stenosis (LSS) surgery, some patients fail to complete all follow-up visits. In recent years, the treatment burden on older adults has attracted increasing attention, with particular emphasis on outpatient visits. Thus, we aimed to clarify the clinical characteristics of older adults who discontinued postoperative follow-up between 1 and 2 years after LSS surgery.

Methods: This retrospective study included consecutive patients aged ≥65 years who had undergone surgery for LSS at a single center between April 2020 and June 2023. At follow-up assessments scheduled 1 and 2 years after surgery, patients completed the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and the Zurich Claudication Questionnaire (ZCQ). The preoperative and 1-year postoperative JOABPEQ and ZCQ scores were statistically compared between patients who did and did not complete follow-up and were adjusted using analysis of covariance or the Poisson regression model.

Results: Among the 330 patients who attended the 1-year follow-up visit, 252 (76.4%) attended the 2-year visit, whereas the remaining 78 (23.6%) did not. Patients who did not complete follow-up exhibited significantly higher rates of dyslipidemia (p=0.022), cardiovascular disease (p=0.005), and frailty (p=0.014), and a lower prevalence of spondylolisthesis (p<0.001) and fusion surgery (p<0.001), than those who completed the follow-up. Furthermore, patients who did not complete follow-up had worse scores in the psychological disorder domain of the JOABPEQ both preoperatively and at 1 year, and worse 1-year scores across all ZCQ domains than those who completed the follow-up.

Conclusions: Several factors were associated with the likelihood of discontinuing postoperative follow-up among older adults with LSS, and their postoperative outcomes were poorer. Therefore, when analyzing data from older adults with LSS at 2 years postoperatively, considering the characteristics of patients who discontinued follow-up is essential.