Adaption And Clinical Application Of The Specific Assessment Instrument In Patients With Degenerative Lumbar Spinal Stenosis

【Objectives】1. To evaluate the validity and reliability of adapted simplified Chinese Swiss spinal stenosis questionnaire.2. To evalute the short to midterm clinical and radiological results of interspinous process device(Coflex)after decompression in treatment of patients with moderate lumbar spinal stenosis.3. To evaluate the significance of the correlation between patient satisfaction and the change in the symptom severity,physical function scores and radiliological parameters.【Methods】1. Adhering to International Quality of Life Assessment Project guidelines, translation and cross-cultural adaptation of the English version of the Swiss Spinal Stenosis Questionnaire was done and the final form of the simplified Chinese Swiss Spinal Stenosis questionnaire was a consensus of the expert committee. To examine the psychometric properties and clinical application of the adapte Chinese SSS, a survey was conducted in a group of randomly selected 105 outpatients and inpaients.There were 30 inpatients and 75 outpatients,43male and 62 female with an average age of 62. A randomly selected 32 patients were collected to evaulate the test-retest reliability with the interval time of 3-5 days.Reliability assessment of the Simplified Chinese version of the SSS was determined by calculating Cronbach'sαand intraclass coefficient (ICC) values. Concurrent validity was evaluated by comparing SSS domains with relevant domains of the simplified Short-Form-36 (SF-36) questionnaire; correlation was made by Pearson Correlation Coefficients (r).2. From December 2008 to July 2009,all included patients(n=21)were treated in the level L4/5. There were male for 8 and female for 13 with mean age of 52 years old. CSSS were used to evaluate the clinical results and lumbar anteroposterior,lateral and flexsion-extension X-ray films were used to measure radiographic changes.The following roentgenografhic parameters were measured preoperatively and follow-ups:the anterior and posterior disc height,height of the neural foramen, the range of motion at the index level. The patients were followed up for average 18 months(range,13-23 months)after the operation.Then,the correlation between patient satisfaction and the change in the symptom severity,physical function scores and radiliological parameters pre-postoperatively was evaluated.【Results】1. Cronbach'sαof the symptom severity scale,physical function scale,patients, satisfaction scale of CSSS are 0.89,0.86,0.91 respectively,which revealed very satisfactory internal consistency. The test/retest reproducibility was found to be excellent as the ICC of three scales were 0.93,0.91,0.95. In terms of concurrent validity, symtem severity scale had good correlation with PF and BP of SF-36,low correlation with MH, The physical function scale hand good correlation with PF of SF-36,while the rest had moderate correlation. The satisfaction scale score was highly correlated with the change in the symptom severity (r=0.71)and physical function(r=0.68)scale scores.2. The postoperative physical function and symptoms severity scores decreased significantly (P<0.001)compared with preoperatively. The posterior disc height and foraminal height increased significantly(P<0.05),but they decreased as the follow-up time prolonged.The anterior disc height did not change significantly while the range of motion at index level decreased over the entire follow-up period.The patient satisfaction had no correlation with the magnitude of radiolographic improvement,but correlated highly with the change in the physical function ( r=0.604)and symptom severity scores( r=0.648).【Conclusions】1. The CSSS has good repeatability and validity.It is equivalent to the original edtion and can be used to assess the disabilities in patients suffering from degenerative lumbar spinal stenosis .2. Interspinous process device termed Coflex after decompressive laminectomy can maintain disc height foraminal height ,which is aimed to decrease the ROM of the surgical level as well as instability. The symptom severity and physical function after surgery improve significantly and 86 percent of the patients feel satisfied. The patient satisfaction had no correlation with the magnitude of radiolographic improvement,but correlates highly with the change in the physical function and symptom severity scores.It suggests that we should pay more attention to patients,self-reported outcome than the radilological parameters..