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Purpose: In this prospective study, we aim to determine surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery., Methods: The study population consisted of 96 LSS patients who underwent decompressive surgery, 72 of whom participated in the 10-year follow-up. The patients completed a questionnaire preoperatively and 3 months, 5 years, and 10 years postoperatively. Outcome measures were satisfaction with the surgical outcomes, the Oswestry Disability Index (ODI), the visual analog scale (VAS), the numeric rating scale (NRS-11), and walking ability quantified in meters. Postoperative improvements at 5 and 10 years were analyzed using linear mixed models. Furthermore, comparisons between postoperative time points were made for clinical courses of pain, disability, and walking ability., Results: At the 10-year follow-up, 68% of the patients were satisfied with the surgical outcomes. All the measured outcomes showed statistically significant improvement from baseline to the 5- and 10-year follow-up. The mean VAS score was 9.8 mm higher at the 5-year follow-up and 7.8 mm at the 10-year follow-up compared to the 3-month follow-up point. Similarly, the mean ODI was 4.8% higher at the 10-year follow-up compared to the 3-month follow-up point., Conclusion: This study reports the clinical course of pain, disability, and walking distance after LSS surgery with the 10-year follow-up. Based on our study results, patients with LSS could expect to have positive effects of their back surgery up to 10 years. However, minor worsening in pain and disability may occur and one-fourth of the patients may need a reoperation during the 10-year follow-up period.

Purpose: It has been shown that the conus medullaris displaces significantly and consistently in response to both unilateral and bilateral SLRs. Point of interest is represented by whether the magnitude of this displacement can be predicted in asymptomatic subjects. The purpose was to investigate whether any correlations existed between demographic and anthropometric factors and hip flexion angle with magnitude of conus medullaris displacement with the unilateral and bilateral SLR. This was done following the notion that there is the possibility that cord movement may contain aspects of predictability in asymptomatic subjects., Methods: Using the same methods as in our previous MRI studies, we further investigated whether any correlations existed between age, height, weight, BMI or hip flexion angle and magnitude of conus medullaris displacement with the unilateral and bilateral SLR., Results: Moderate to strong positive correlation was found between degree of hip flexion and magnitude of conus medullaris caudal displacement with unilateral and bilateral SLRs and CuMeD. A negligible inverse correlation between subjects' height and magnitude of conus medullaris displacement in response to unilateral SLR was found, while no correlation (r < 0.1) emerged with bilateral SLR and CuMeD. No correlation was found for other values such as age, weight or BMI., Conclusions: The data show that in in vivo and structurally intact asymptomatic volunteers, the degree of hip flexion may have strong predictive values for magnitude of neural displacement in response to unilateral and bilateral SLRs. This provides further justification to its quantification in clinical settings. Magnitude of conus medullaris displacement in response to unilateral and bilateral SLRs is not likely to be predicted from easily clinically collectable measures such as age, height, weight and BMI. This study offers information relevant to investigation of prediction of neuromechanical responses in neurodynamic tests.

Purpose: Chronic low back pain and lumbar spinal stenosis (LSS) seem to deteriorate lumbar muscle function and proprioception but the effect of surgery on them remains unclear. This study evaluates the effect of decompressive surgery on lumbar movement perception and paraspinal and biceps brachii (BB) muscle responses during sudden upper limb loading in LSS., Methods: Low back and radicular pain intensity (VAS) and Oswestry Disability Index (ODI) were measured together with lumbar proprioception and paraspinal and BB muscle responses prior to and 3 and 24 months after surgery in 30 LSS patients. Lumbar proprioception was assessed by a previously validated motorized trunk rotation unit and muscle responses for sudden upper limb loading by surface EMG., Results: Lumbar perception threshold improved after surgery during 3-month follow-up (from 4.6° to 3.1°, P = 0.015) but tend to deteriorate again during 24 months (4.0°, P = 0.227). Preparatory paraspinal and BB muscle responses prior to sudden load as well as paraspinal muscle activation latencies after the load remained unchanged., Conclusion: Impaired lumbar proprioception seems to improve shortly after decompressive surgery but tends to deteriorate again with longer follow-up despite the sustaining favorable clinical outcome. The surgery did not affect either the feed-forward or the feed-back muscle function, which indicates that the abnormal muscle activity in LSS is at least partly irreversible.

Introduction: Impaired muscle function and lumbar proprioception have been observed in lumbar spinal stenosis (LSS) but those have not been studied in LSS patients with age-matched controls. We assessed lumbar movement perception and paraspinal and biceps brachii (BB) muscle responses during sudden upper limb loading in age-matched healthy subjects and patients with LSS., Methods: The study included 30 patients selected for an operation due to LSS and 30 age-matched controls without chronic back pain. The paraspinal and BB muscle responses for upper limb loading during unexpected and expected conditions were measured by surface EMG. The ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in a seated position. Pain, disability and depression scores were recorded., Results: Patients had poorer lumbar perception (mean difference 2.3 ± 0.6°, P < 0.001) and longer paraspinal muscle response latencies [mean difference 4.6 ± 0.6 ms (P = 0.033)] than age-matched healthy controls. Anticipation increased paraspinal and BB muscle activation prior to the load perturbation (P < 0.001) but less in LSS patients than in controls [9 vs. 30 %, P = 0.016 (paraspinals); 68 vs. 118 %, P = 0.047 (BB)]., Conclusions: The observed impairments in lumbar proprioception and activation of paraspinal and upper limb muscles indicate an extensive loss of both sensory and motor functions in LSS. The main new finding was decreased anticipatory muscle activation during expected upper limb loading reflecting involvement of central movement control mechanisms.

Unlabelled: INTRODUCTION AND MATERIALS: We examined lumbar transpedicular instrumented posterolateral fusion patients operated on between 1992 and 1997 presenting: degenerative spondylolisthesis with spinal stenosis; adult isthmic spondylolisthesis; failed back syndrome after one to five discectomies; and failed back syndrome after one to three laminectomy operations (groups 1-4, respectively)., Methods: They were examined by an independent orthopedic surgeon, completed the Oswestry Disability Index (ODI) and visual analog scale (VAS) questionnaires and their outcome was evaluated., Results: The overall patient satisfaction at follow-up (mean 11.7 years) was 82.1%. The reoperation rate was 15.1% (7.5% due to adjacent segment disease)., Conclusion: Group 1 showed the greatest improvements in ODI and VAS values, Group 2 the lowest and Group 3 the highest preoperative values, and Group 4 the second highest improvements. Patient satisfaction scores were 90.3, 69.7, 63.6 and 80.0%, respectively, and unplanned reoperation rates were 6.5, 9.1, 31.8 and 20.0%. Thus, long-term outcomes of lumbar instrumented posterolateral fusion (rarely previously studied) were satisfactory for >80% of patients, but varied among groups.

The aim was to study if postoperative rehabilitation improves functional outcome in lumbar spinal stenosis (LSS). Surgically treated LSS patients (n = 102) were randomized to rehabilitation-group (A) and "standard postoperative treatment"--group (B). Intervention for A-group started 3 months postoperatively, consisting of once a week outpatient visits for 12 weeks (1.5 h per visit; 1-6 patients per one physiotherapist). Physiotherapist guided stretching and strengthening exercises. A-group performed individually estimated exercises at those visits with guiding and at home up to 24-month postoperative follow-up. Physiotherapeutic guidance (12 times) was repeated after 12 months, in order to update exercises and motivate patients to keep training. For B-group, the "standard treatment" thus included normal postoperative treatment, or no treatment/self-management. Outcome measures were measured at the start and the end of the first physiotherapeutic intervention (3 and 6 months postoperatively), and at 12- and 24-month postoperative follow-ups. Oswestry Disability Index (ODI, 0-100%) was the main outcome measure. The other outcome measures were back- and leg pain separately (NRS-11); satisfaction (7-point scale) and treadmill test (0-1,000 m; not at 6 month). The intervention consisting of 12 + 12 physiotherapeutic sessions with further home exercises did not influence the course ODI in the 24-month postoperative follow-up (p = 0.95 for ODI; "as-rehabilitated" analysis). No influence on any other outcome measures was observed. After LSS surgery, routinely performed outpatient rehabilitation did not improve functional outcome compared to standard treatment. In addition, it had no impact on the back and leg pain, satisfaction and walking ability.

The aim of this study was to examine the life satisfaction of lumbar spinal stenosis (LSS) patients up to the 2-year postoperative phase. Patients (N = 102, mean age, 62 years) with symptomatic LSS underwent decompressive surgery. Data collection took place with the same set of questionnaires before surgery and 3 months, 6 months, 1 year and 2 years postoperatively. Life satisfaction was assessed with the four-item Life Satisfaction scale and depression symptoms with the 21-item Beck Depression Inventory (BDI). In addition, a depression burden variable was included, comprising the sum of preoperative, 3- and 6-month BDI scores. Physical functioning and pain were assessed with the Oswestry disability index, Stucki questionnaire, self-reported walking ability, visual analogy scale and pain drawing. Two years postoperatively, 18% of the LSS patients was dissatisfied with their lives. As a whole, the life satisfaction of the LSS patients improved during the postoperative follow-up, reaching the level of the healthy adult Finnish population. However, 2 years postoperatively, dissatisfied patients reported significantly more pain, a poorer functional ability and more depressive symptoms and depression than the patients who were satisfied with life. This difference was seen throughout the postoperative follow up. In regression analyses, the only significant associations were between the depression burden and postoperative life dissatisfaction. Thus, subjective well-being as well as depression among LSS patients should be assessed pre- and postoperatively in order to enable early intervention for those at risk of poorer life satisfaction.

The objective of the study was to examine self-reported life satisfaction and associated factors in patients (n=100) with lumbar spinal stenosis (LSS) in secondary care level, selected for surgical treatment. Life satisfaction was assessed with the four-item Life Satisfaction scale. Depression was assessed with a 21-item Beck Depression Inventory (BDI). Psychological well-being was assessed with Toronto Alexithymia Scale and Sense of Coherence Scale. LSS related physical functioning and pain were assessed with Oswestry disability index, Stucki questionnaire, Visual Analogue Scale and pain drawings. All questionnaires were administered before surgical treatment of LSS. Results showed that 25% of the patients with LSS were found to be dissatisfied with life. In a univariate analysis, smoking, elevated subjective disability scores and extensive markings in the pain drawings were more common in the dissatisfied patients. The dissatisfied patients also showed lower coping resources, elevated alexithymia and depression scores, and were more often depressed. In multiple logistic regression analyses, only younger age and somatic comorbidity were associated with life dissatisfaction. This association remained significant even when the BDI score was added into the model. No other significant associations emerged. In conclusion, life dissatisfaction was rather common among preoperative LSS patients. Pain and constraints on everyday functioning were important correlates of life dissatisfaction. However, only younger age and somatic comorbidity were independently associated with life dissatisfaction. These results emphasize the importance of recognizing and assessing the effect of coexisting medical conditions and they need to be addressed in any treatment program.

The objective of this observational prospective study was to investigate the effect of depression on short-term outcome after lumbar spinal stenosis (LSS) surgery. Surgery was performed on 99 patients with clinically and radiologically defined LSS, representing ordinary LSS patients treated at the secondary care level. They completed questionnaires before surgery and 3 months postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with Oswestry disability index, Stucki Questionnaire, self-reported walking ability, visual analogue scale (VAS) and pain drawing. Preoperatively, 20% of the patients had depression. In logistic regression analyses, significant associations were seen between preoperative depression and postoperative high Oswestry disability and Stucki severity scores and high intensity of pain (VAS score). In subsequent analyses, the patients with continuous depression, measured with BDI (60% of the patients who had preoperative depression), showed fewer improvements in symptom severity, disability score, pain intensity and walking capacity than the patients who did not experience depression at any phase. In those patients who recovered from depression, according to BDI-scores (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. In the surgical treatment of LSS, we recommend that the clinical practice should include an assessment of depression.

The aim of the present study was to investigate cross-sectionally the association of postmenopausal muscle strength with simple performance tests. A random sample of 1,166 naturally postmenopausal women (born 1932-1941) was selected from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort. Grip and quadriceps strength were measured with strain gauge dynamometers and reported in both absolute values (KPa and kg) and per kilogram of body mass (N cm(-2) kg(-1) and N kg(-1)). In addition, two performance tests, 'ability to stand on one foot' and 'ability to squat down to touch the floor' were carried out. A five-category self-assessment of overall health ('very good', 'good', 'moderate', 'bad', and 'very bad') was obtained by postal questionnaire. The women that were able to stand on one foot and able to squat down to touch the floor had greater grip and quadriceps strength than their counterparts ( P<0.001 and P<0.03 in ANOVA, respectively). In addition, self-assessed health had a strong positive association with muscle strength in the grip and leg extensor muscles in ANOVA ( P<0.001 between 'very good' and 'moderate' or poorer state of health) and regression model ( P<0.001). Adjustment for age, duration of menopause, body mass, height, physical activity level, use of HRT, and number of diseases and medications did not change any of the main effects. Also, there were no differences in results between absolute measurement values and values reported per kilogram of body mass. According to the present study, a simple performance test may be useful in the prediction of postmenopausal muscle strength. Furthermore, self-assessed state of health is strongly associated with muscle strength in postmenopausal women.

The aim of this study was to define the influence of whiplash injuries on the perceived condition of health 3 years after injury. We evaluated remaining symptoms and the use of health services. Insurance companies provided reports and medical certificates from traffic accidents in Finland in 1998, for those injured who had agreed to take part in the study. Participants in the 1-year follow-up study answered a self-report questionnaire. Three years after the whiplash-causing accident, 11.8% of participants reported that injury symptoms had caused their health to deteriorate significantly as compared with before the accident. Neck pain was the most common single symptom, reported by 14.6% of respondents. The severity of the initial symptoms according to the WAD classification is reflected in the subject's self-perception of health after 3 years. A remarkable 10-17% of respondents still used health services regularly because of the symptoms. Although some of the injured had improved in the long term, some reported that their health condition was worse after 3 years than at the 1-year follow-up. The percentage of respondents reporting a significant health deterioration remains unchanged 3 years after the whiplash injury. These findings illuminate the importance of early recognition of risk factors for long-term disability and the primary treatment and rehabilitation procedures.

The paraspinal muscle responses for unexpected and expected upper limb loading were investigated by surface EMG of 20 healthy volunteers. The simultaneous trunk and hand accelerations with paraspinal, biceps brachii and soleus muscles EMG were measured in four subjects. A short-latency response of approximately 50 ms was observed in paraspinal muscles. The latency was approximately 3 ms shorter (P = 0.017) during "expected" trials on average and the latency shortened during the first three expected trials (P = 0.02). Anticipation also decreased the magnitude of the response (P < 0.05). Trunk movement initiated approximately 35 ms and approximately 50 ms after the impact of the load at T6 and T12 levels, respectively. In conclusion, visual expectation shortens the latency and decreases the magnitude of the paraspinal muscle response to sudden upper limb loading. Also, the trial repetition has an effect on reflex latency if visual information is available. These results indicate that anticipation modulates the reflex control of paraspinal muscles, which may be significant in understanding spinal function.