The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis

Amandine Bays; Andrea Stieger; Ulrike Held; Lisa J Hofer; Eva Rasmussen-Barr; Florian Brunner; Johann Steurer; Maria M Wertli

doi:10.1016/j.xnsj.2021.100072

The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis

N Am Spine Soc J. 2021 Jun 2:6:100072. doi: 10.1016/j.xnsj.2021.100072. eCollection 2021 Jun.

Authors

Amandine Bays¹, Andrea Stieger¹, Ulrike Held², Lisa J Hofer², Eva Rasmussen-Barr³, Florian Brunner⁴, Johann Steurer⁵, Maria M Wertli^{1

5}

Affiliations

¹ Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland.
² Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
³ Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden.
⁴ Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
⁵ Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland.

Abstract

Background: Lumbar spinal stenosis (LSS) affects mainly elderly patients. To this day, it is unclear whether comorbidities influence treatment success. The aim of this systematic review and meta-analysis was to assess the impact of comorbidities on the treatment effectiveness in symptomatic LSS.

Methods: We conducted a systematic review and meta-analysis and reviewed prospective or retrospective studies from Medline, Embase, Cochrane Library and CINAHL from inception to May 2020, including adult patients with LSS undergoing surgical or conservative treatment. Main outcomes were satisfaction, functional and symptoms improvement, and adverse events (AE). Proportions of outcomes within two subgroups of a comorbidity were compared with risk ratio (RR) as summary measure. Availability of ≥3 studies for the same subgroup and outcome was required for meta-analysis.

Results: Of 72 publications, 51 studies, mostly assessing surgery, there was no evidence reported that patients with comorbidities were less satisfied compared to patients without comorbidities (RR 1.06, 95% confidence interval (CI) 0.77 to 1.45, $I^{2}$ 94%), but they had an increased risk for AE (RR 1.46, 95% CI 1.06 to 2.01, $I^{2}$ 72%). A limited number of studies found no influence of comorbidities on functional and symptoms improvement. Older age did not affect satisfaction, symptoms and functional improvement, and AE (age >80 years RR 1.22, 95% CI 0.98 to 1.52, $I^{2}$ 60%). Diabetes was associated with more AE (RR 1.72, 95% CI 1.19 to 2.47, $I^{2}$ 58%).

Conclusion: In patients with LSS and comorbidities (in particular diabetes), a higher risk for AE should be considered in the treatment decision. Older age alone was not associated with an increased risk for AE, less functional and symptoms improvement, and less treatment satisfaction.

Keywords: Adverse events; Chronic disease; Comorbidities; Diabetes; Elderly; Lumbar spinal stenosis; Meta-analysis; Spine surgery; Systematic review; Treatment outcome.

Publication types

Review