Preoperative Health Status and Clinical Predictors of Health-Related Quality of Life Improvement After Lumbar Spinal Stenosis Surgery: A Longitudinal Study

Background/Objectives: Limited research has examined the relationship between preoperative health status and health-related quality of life (HRQoL) in patients with lumbar spinal stenosis (LSS) undergoing surgery. This study aims to assess the role of clinical, preoperative health and demographic factors on short-term HRQoL and functional outcomes following LSS surgery. Methods: A longitudinal study was conducted on 61 LSS patients (mean age 72.2 ± 8.8 years) undergoing surgery, assessing HRQoL and clinical outcomes before and 30 days post-surgery. Demographic and preoperative health status data were collected at baseline. HRQoL was measured using the Short Form Health Survey 36 (SF-36); clinical evaluations included assessments of disability, pain, and psychological status. Changes in HRQoL and clinical scores were analyzed with repeated measures ANOVA. HRQoL improvement was correlated with demographic and clinical variables, using Pearson’s correlation. Results: Spinal surgery for LSS led to significant improvements in HRQoL, with notable gains in both physical and mental health components (both p < 0.001), and in particular, in the body pain (+34%) and physical functioning, role physical, and social functioning (+20%) subscales of SF-36. Clinical scores also showed significant post-surgery improvements, strongly correlating with HRQoL. Correlations between ∆SF-36 subscale scores and preoperative factors revealed negative associations with BMI, smoking, comorbidities, and psychological distress. Conversely, physical activity was positively correlated with HRQoL improvements, especially in items showing the greatest score increases. Conclusions: Surgical treatment for LSS determines a significant improvement in HRQoL and functional outcome, which are however influenced by preoperative factors such as psychological distress, high BMI, smoking, and comorbidities. Conversely, regular physical activity is associated with better daily functioning, work performance, and social engagement. A comprehensive preoperative assessment may be a useful and appropriate tool to identify patients who are most likely to benefit and optimize quality of life after LSS surgery.