Background context:

In the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population.

Purpose:

Document the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability post-surgery.

Design:

Prospective study of consecutive patients followed to 12-months post-surgery.

Patient sample:

Patients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA.

Outcomes measures:

Patient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-months post-surgery; and, completed pre-surgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and “pain/stiffness/swelling most days of the month” indicated on a homunculus (a joint site count was derived).

Assessments:

Height and weight, used to calculate body mass index; timed-up-and-go performance-based test.

Methods:

Outcome of interest was achieving a clinically important improvement (CII) in ODI by 12-months post-surgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures.

Results:

In all, 165 patients were included. The mean age was 67 years (range:44-90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared to 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio: 1.32, 95% CI: 1.51, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was pre-surgery anxiety (odds ratio: 2.97, 95% CI: 1.02, 8.65), opioid use (odds ratio: 2.89, 95% CI: 1.07, 7.82) and worse back pain intensity score (odds ratio: 1.27, 95% CI: 1.05, 1.53).

Conclusions:

Multijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer post-surgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for post-surgical rehabilitation and self-management strategies.