Health-related quality of life and comorbidities associated with lumbar spinal stenosis

Abstract Background context Spinal stenosis is one of the most commonly diagnosed pathologies of the lumbar spine and the leading indication for spine surgery in adults aged 65 years and older. Yet, the burden of lumbar spinal stenosis (LSS) alone, and in combination with common comorbidities, on health-related quality of life (HRQL) is unknown as are comorbidities specifically associated with this chronic condition. Purpose To estimate the illness burden of LSS on HRQL, adjusting for the effects of specific comorbidities, age, and gender, and investigate whether specific comorbidities are associated with the condition. Study design/setting A community-based cohort of 245 patients diagnosed with LSS was assembled and compared with a representative sample of 7,489 adults from the base population of Albertans responding to the Canadian Community Health Survey on HRQL and comorbidities. Methods Health-related quality-of-life data were acquired through interviews for both groups using the Health Utilities Index Mark 3 (HUI3). Both groups were also queried about the presence of 13 specific chronic conditions. Linear regression was used to model HUI3 scores as a function of group, age, gender, and specific comorbid conditions. Logistic regression was used to compare the odds of having particular comorbid conditions between the LSS and general population groups. Results The mean unadjusted overall HUI3 scores were 0.60 for the LSS group and 0.85 for the general population (1=perfect health). After adjustment, HRQL deficits four times that deemed a clinically important difference remained between the groups. Controlling age and gender, the prevalence of arthritis, migraines, hypertension, and incontinence was significantly greater in the LSS group as compared with the general population sample. Conclusions Diagnosed LSS is associated with a very substantial burden of illness that is compounded by associated comorbidities, with implications for clinical care, health-care policy decisions, and research. Attention to comorbidities is particularly important in LSS.