gms | German Medical Science

Objective: Demographic changes in the last decades led to an increase in the number of the elderly population going along with an increase in the prevalence of degenerative disc diseases. Degenerative lumbar stenosis results from facet joint degenerations, osteophyte formations and ligamentum flavum hypertrophies and is associated with a lot of discomfort and limitations in activities of daily living (ADL). Hence, symptomatic lumbar stenosis is one of the most frequent indications for spinal surgery. The aim of this study was to investigate whether morphological markers, depression as well as age can predict pain intensity, the execution of ADL and fear of movements in patients suffering from lumbar stenosis.

Methods: Sixty-seven patients with lumbar spine stenosis (mean age of 62.5 [11.7], 50.7% females) participated in the study. Linear regression analyses were used to predict self-reported pain intensity (VAS), interference of pain with the performance of ADL (PI-G), ADL (RehaCAT), participation in social life (AAPI) and fear of movement (TSK_GV). As predictors age, self-reported depression (DESC) and morphological markers (severity of the lumbar stenosis indexed with MRI evaluation using the Schizas classification, the number of affected segments and the presence of spondylolisthesis) were used.

Results: The results of the linear regression analyses revealed that all dependent variables are significantly predicted by depression, age and the morphological markers. A significant proportion of variance is explained with R² ranging between 12.4 (PI-G-physical) and 53.8 (VAS). It was additionally investigated which of the predictors significantly contributed to the explained variance using the stepwise-method. Depression is the most powerful predictor for all dependent variables and at the same time the unique predictor for most of them. Exceptions are pain intensity which is also significantly predicted by age and the number of affected segments, as well as fear of movement and ADL requiring lower extremity function which are both also predicted by the severity of the lumbar stenosis.

Conclusion: A high depression score, probably indicating deficient adaptation and coping regarding the disease and its consequences, is the most important predictor for limitations in ADL and participation. The morphological markers contribute to predict self-reported pain intensity, activity avoidance and ADLs requiring lower extremity function.