The Clinical Status of Patients With Lumbar Spinal Stenosis Reflects Their Individual Decision to Undergo or Defer Lumbar Spinal Surgery

Objective: To evaluate whether functional, clinical, and self-reported tests reflect lumbar spinal stenosis patients’ decisions to undergo or defer surgery. Methods: Among 108 participants, 77 chose surgery (SG), and 31 opted to wait and see (WaSG) whether they got better spontaneously. Both groups were assessed at baseline (t₀) and 3 months (t₁), with additional self-reported measures at 6 (t₂) and 12 months (t₃). Key outcomes included corridor walk distance, chair sit-to-stand repetitions, grip strength, and various pain and disability indices. Results: At baseline, SG reported higher leg pain (NPRS-leg: D = 1.66, P = 0.002) and poorer functional outcomes across multiple tests. By t₁, both groups improved in disability, but SG showed greater reductions in the Oswestry Disability Index (D = 7.85, P = 0.001) and sustained improvements in leg pain at subsequent assessments. WaSG consistently engaged in more walking (mean D = 123.5 minutes, P, 0.001). Regression analyses indicated that surgery status, flexibility, and strength significantly predicted improvements in disability (adjusted R = 0.296). Logistic regression identified predictors for surgery choice, including biological sex, leg pain intensity, walking performance, and weekly walking hours. Conclusion: Functional status, self-reported disability, and fear-avoidance beliefs in lumbar spinal stenosis patients reflect their subjective decision regarding surgery and highlight the importance of baseline leg pain, calf strength, walking-related parameters, and physical function in recovery. Study Design: Observational prospective cohort.