{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T10:05:06Z","timestamp":1782295506766,"version":"3.54.5"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,12]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Mid- to long-term data on the natural history of degenerative lumbar spinal stenosis (LSS) remain limited as surgery is increasingly favored. The aim of this study was to characterize the prevalence of clinical deterioration over long-term follow-up and to identify risk and protective factors.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n In this retrospective cohort study, adult patients with symptomatic LSS and a follow-up period \u2265 5 years were analyzed. Clinical deterioration was defined by at least one of the following factors: myotomal lower limb weakness, sphincter disturbance, or a decrease in walking tolerance to \u2264 10 minutes due to neurogenic claudication. Radiological assessment included standing lumbar radiographs and lumbosacral MR images obtained after symptom onset. A univariate analysis was performed, with variables demonstrating significance levels of p < 0.1 included in the subsequent multivariable logistic regression analysis. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival curves were plotted for statistically significant risk factors.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n A total of 202 patients with symptomatic LSS and adequate follow-up were included. The mean age was 65.2 \u00b1 4.2 years at the onset of neurological symptoms and the mean follow-up duration was 121 \u00b1 40 months. Clinical deterioration occurred in 39 patients (19.3%). Among those with deterioration, 36 (92.3%) reported reduced walking tolerance due to neurogenic claudication, 8 (20.5%) had myotomal weakness, and 2 (5.1%) experienced sphincter disturbance. Upon multivariate analysis, the presence of lumbar developmental spinal stenosis was a risk factor for deterioration (p = 0.031), while an increased dural sac area was protective (p = 0.045); adjusted hazard ratios were 10.11 and 0.98, respectively. A dural sac area < 55 mm\n 2<\/jats:sup>\n had an area under the ROC curve of 0.781 for predicting clinical deterioration within 5 years of symptom onset.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Patients with lumbar stenosis and neurogenic claudication mostly remained ambulatory without developing motor deficits or sphincter dysfunction. Conservative management is an option for patients with tolerable symptomatology and low functional expectations, especially in the absence of the identified risk factors of developmental narrowing of lumbar canal dimensions and critically reduced dural sac area over the most stenotic level.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.5.spine25215","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:35:00Z","timestamp":1757687700000},"page":"641-650","source":"Crossref","is-referenced-by-count":2,"title":["Mid- to long-term natural history of degenerative lumbar spinal stenosis and predictors for clinical deterioration"],"prefix":"10.3171","volume":"43","author":[{"given":"Samuel Yan-Lik","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janus Siu-Him","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guodong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry Long-Hei","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason Pui-Yin","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham Ka-Hon","family":"Shea","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"17","key":"b1","series-title":"JAMA","first-page":"1688","article-title":"Diagnosis and management of lumbar spinal stenosis: a review","volume":"327","author":"Katz JN","year":"2022","unstructured":"Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and management of lumbar spinal stenosis: a review. JAMA. 2022;327(17):1688\u20131699."},{"issue":"6","key":"b2","series-title":"Global Spine J","first-page":"1084","article-title":"Prevalence and definition of multilevel lumbar developmental spinal stenosis","volume":"12","author":"Lai MKL","year":"2022","unstructured":"Lai MKL, Cheung PWH, Samartzis D, Cheung JPY. Prevalence and definition of multilevel lumbar developmental spinal stenosis. Global Spine J. 2022;12(6):1084\u20131090."},{"issue":"2","key":"b3","series-title":"World J Orthop","first-page":"134","article-title":"Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis","volume":"5","author":"Kobayashi S","year":"2014","unstructured":"Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World J Orthop. 2014;5(2):134\u2013145."},{"issue":"4","key":"b4","series-title":"J Spinal Disord Tech","first-page":"334","article-title":"Cauda equina syndrome in lumbar spinal stenosis: case report and incidence in Jutland, Denmark","volume":"17","author":"Johnsson KE","year":"2004","unstructured":"Johnsson KE, Sass M. Cauda equina syndrome in lumbar spinal stenosis: case report and incidence in Jutland, Denmark. J Spinal Disord Tech. 2004;17(4):334\u2013335."},{"issue":"3","key":"b5","series-title":"J Orthop","first-page":"123","article-title":"Lumbar spinal canal stenosis-special features","volume":"12","author":"Gopinathan P","year":"2015","unstructured":"Gopinathan P. Lumbar spinal canal stenosis-special features. J Orthop. 2015;12(3):123\u2013125."},{"issue":"11","key":"b6","series-title":"J Bone Joint Surg Am","first-page":"1954","article-title":"A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication","volume":"84","author":"Yukawa Y","year":"2002","unstructured":"Yukawa Y, Lenke LG, Tenhula J, Bridwell KH, Riew KD, Blanke K. A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. J Bone Joint Surg Am. 2002;84(11):1954\u20131959."},{"issue":"7","key":"b7","series-title":"Spine J","first-page":"545","article-title":"Spinal stenosis prevalence and association with symptoms: the Framingham Study","volume":"9","author":"Kalichman L","year":"2009","unstructured":"Kalichman L, Cole R, Kim DH, Spinal stenosis prevalence and association with symptoms: the Framingham Study. 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Clin Orthop Relat Res. 1992;279(279):82\u201386."},{"issue":"14","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"1329","article-title":"Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial","volume":"35","author":"Weinstein JN","year":"2010","unstructured":"Weinstein JN, Tosteson TD, Lurie JD, Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. 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Arch Rehabil Res Clin Transl. 2022;4(4):100227."},{"issue":"3","key":"b28","series-title":"J Neurosurg Spine","first-page":"353","article-title":"Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge","volume":"26","author":"Murphy ME","year":"2017","unstructured":"Murphy ME, Gilder H, Maloney PR, Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge. J Neurosurg Spine. 2017;26(3):353\u2013362."},{"issue":"11","key":"b29","series-title":"J Bone Joint Surg Am","first-page":"2089","article-title":"Perioperative complications of posterior lumbar decompression and arthrodesis in older adults","volume":"85","author":"Carreon LY","year":"2003","unstructured":"Carreon LY, Puno RM, Dimar JR, II, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. 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Eur Spine J. 2020;29(9):2173\u20132187."},{"issue":"4","key":"b32","series-title":"Spine (Phila Pa 1976)","first-page":"439","article-title":"Does multilevel lumbar stenosis lead to poorer outcomes?: A subanalysis of the Spine Patient Outcomes Research Trial (SPORT) lumbar stenosis study","volume":"35","author":"Park DK","year":"2010","unstructured":"Park DK, An HS, Lurie JD, Does multilevel lumbar stenosis lead to poorer outcomes?: A subanalysis of the Spine Patient Outcomes Research Trial (SPORT) lumbar stenosis study. Spine (Phila Pa 1976). 2010;35(4):439\u2013446."},{"issue":"10","key":"b33","series-title":"Spine J","first-page":"2132","article-title":"Circulatory dynamics of the cauda equina in lumbar canal stenosis using dynamic contrast-enhanced magnetic resonance imaging","volume":"15","author":"Kobayashi S","year":"2015","unstructured":"Kobayashi S, Suzuki Y, Meir A, Al-Khudairi N, Nakane T, Hayakawa K. 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