Risk of same-level recurrent stenosis requiring surgery after laminectomy for lumbar spinal stenosis

Purpose: Same-level recurrent stenosis requiring surgery (SLRS-S) may occur after laminectomy for lumbar spinal stenosis (LSS), leading to significant discomfort and radicular pain. The purpose of this study was to indentify factors independently associated with SLRS-S after laminectomy for LSS. Methods: With a case-control analysis nested in a historical cohort of patients who had laminectomy for LSS between January 2006 and December 2010, we identified 64 cases with SLRS-S. To identify the risk factors for SLRS-S, we selected 64 control patients who were matched in a 1: 1 manner to the SLRS-S patients according to age, sex, decompressed segments, and follow-up duration. Univariate analysis and a multivariate logistic regression were performed. Results: Multivariate logistic regression analysis indicated that higher body mass index (BMI, odds ratio [OR]=1.157, 95% confidence interval [CI]= 1.034-1.294, P=0.011), preoperative facet joint degeneration on computed tomography examination (OR=3.282, 95% CI=1.745-6.172, P=0.000), and a smaller relative cross-sectional area (rCSA) of the paraspinal muscle preoperatively (OR=0.136, 95% CI=0.042-0.438, P=0.001) were significant factors for predicting SLRS-S. Conclusion: The SLRS-S after laminectomy for LSS is most likely multifactorial, and is associated with a higher BMI, preoperative facet joint degeneration on computed tomography examination, and a smaller rCSA of the paraspinal muscle preoperatively.