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

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Title: The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis
Authors: Amandine Bays, Andrea Stieger, Ulrike Held, Lisa J Hofer, Eva Rasmussen-Barr, Florian Brunner, Johann Steurer, Maria M Wertli
Source: North American Spine Society Journal, Vol 6, Iss , Pp 100072- (2021)
Publisher Information: Elsevier, 2021.
Publication Year: 2021
Collection: LCC:Orthopedic surgery
LCC:Neurology. Diseases of the nervous system
Subject Terms: Lumbar spinal stenosis, Comorbidities, Chronic disease, Systematic review, Meta-analysis, Treatment outcome, Orthopedic surgery, RD701-811, Neurology. Diseases of the nervous system, RC346-429
More Details: 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, I2 94%), but they had an increased risk for AE (RR 1.46, 95% CI 1.06 to 2.01, I2 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, I2 60%). Diabetes was associated with more AE (RR 1.72, 95% CI 1.19 to 2.47, I2 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.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2666-5484
Relation: http://www.sciencedirect.com/science/article/pii/S266654842100024X; https://doaj.org/toc/2666-5484
DOI: 10.1016/j.xnsj.2021.100072
Access URL: https://doaj.org/article/da1ff74a30b944d0983588f367b7673e
Accession Number: edsdoj.1ff74a30b944d0983588f367b7673e
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  Data: The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis
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  Data: North American Spine Society Journal, Vol 6, Iss , Pp 100072- (2021)
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  Data: <searchLink fieldCode="DE" term="%22Lumbar+spinal+stenosis%22">Lumbar spinal stenosis</searchLink><br /><searchLink fieldCode="DE" term="%22Comorbidities%22">Comorbidities</searchLink><br /><searchLink fieldCode="DE" term="%22Chronic+disease%22">Chronic disease</searchLink><br /><searchLink fieldCode="DE" term="%22Systematic+review%22">Systematic review</searchLink><br /><searchLink fieldCode="DE" term="%22Meta-analysis%22">Meta-analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+outcome%22">Treatment outcome</searchLink><br /><searchLink fieldCode="DE" term="%22Orthopedic+surgery%22">Orthopedic surgery</searchLink><br /><searchLink fieldCode="DE" term="%22RD701-811%22">RD701-811</searchLink><br /><searchLink fieldCode="DE" term="%22Neurology%2E+Diseases+of+the+nervous+system%22">Neurology. Diseases of the nervous system</searchLink><br /><searchLink fieldCode="DE" term="%22RC346-429%22">RC346-429</searchLink>
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  Data: 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, I2 94%), but they had an increased risk for AE (RR 1.46, 95% CI 1.06 to 2.01, I2 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, I2 60%). Diabetes was associated with more AE (RR 1.72, 95% CI 1.19 to 2.47, I2 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.
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      – SubjectFull: Lumbar spinal stenosis
        Type: general
      – SubjectFull: Comorbidities
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      – SubjectFull: Chronic disease
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