Introduction: Lumbar spinal stenosis (LSS), common in older adults due to degenerative disc disease, often requires surgery for cases unresponsive to other treatments. Despite minimally invasive advances, careful patient selection is crucial, as severe stenosis, low bone density, or chronic pain can lead to poor outcomes. This underscores the need for better predictive models to optimize surgical decisions and reduce postoperative disability. Our aim is to evaluate predictive factors for failure and worsening outcomes after lumbar spine decompression in degenerative spinal disease.
Methods: A systematic review was conducted using PRISMA guidelines to evaluate the literature on clinical and radiological predictors of decompression failure in LSS surgery. Studies from inception to October 2024 were systematically screened from four databases. Data regarding study design, patient demographics, procedure characteristics, and clinical and radiological outcomes were collected. A meta-analysis compared predictors associated with successful and unsuccessful decompression outcomes.
Results: Out of 4,096 studies, 29 met the inclusion criteria, encompassing 20,676 patients. The majority were 60-70 years old, with a BMI over 25. Smoking (14-48%) and diabetes (10-27%) were prevalent, and 20-27% had an ASA grade >2. Chronic back pain lasting over a year affected up to 70% of patients. Age was a significant predictor of failure, with Cohen’s d = 0.16 (95% CI: 0.04–0.27, p = 0.01) and a pooled SMD of 0.21 (95% CI: 0.08–0.33), showing moderate heterogeneity (I² = 52%) between studies. No significant associations were observed for BMI, preoperative ODI, or other risk factors.
Conclusion : This review identified age as a significant predictor of worse functional outcomes in elderly patients. No other predictors showed a significant association with failure, highlighting the need for more consistent research to identify additional risk factors for poor outcomes.
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