Background Lumbar spinal stenosis (LSS) reduces walking and quality of life. It is the main indication for spinal surgery in older people yet 40% report walking disability post-operatively. Identifying the prognostic factors of post-operative walking capacity could aid clinical decision-making, guide rehabilitation and optimise health outcomes. Objective To synthesise the evidence for pre-operative mutable and immutable prognostic factors for post-operative walking in adults with LSS. Design Systematic review with narrative synthesis. Methods Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, OpenGrey) were searched for observational studies, evaluating factors associated with walking after surgery in adults receiving surgery for LSS from database inception to January 2020. Two reviewers independently evaluated studies for eligibility, extracted data and assessed risk of bias (Quality in Prognosis Studies). The Grading of Recommendations Assessment, Development and Evaluation method was used to determine level of evidence for each factor. Results 5526 studies were screened for eligibility. Thirty-four studies (20 cohorts, 9,973 participants, 26 high, 2 moderate, 6 low risk of bias) were included. Forty variables (12 mutable) were identified. There was moderate quality of evidence that pre-operative walking capacity was positively associated with post-operative walking capacity. The presence of spondylolisthesis and the severity of stenosis were not associated with post-operative walking capacity. All other factors investigated had low/very low level of evidence. Conclusion Greater pre-operative walking is associated with greater post-operative walking capacity but not spondylolisthesis or severity of stenosis. Few studies have investigated mutable prognostic factors that could be potentially targeted to optimise surgical outcomes.

中文翻译：

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腰椎管狭窄症术后步行能力的术前预后因素：系统评价

背景 腰椎管狭窄症 (LSS) 会降低步行和生活质量。它是老年人脊柱手术的主要适应症，但 40% 的人报告术后出现行走障碍。确定术后步行能力的预后因素可以帮助临床决策、指导康复和优化健康结果。目的 总结 LSS 成人术后行走的术前可变和不可变预后因素的证据。设计系统回顾与叙述综合。方法 搜索电子数据库（CENTRAL、MEDLINE、EMBASE、CINAHL、PsycINFO、Web of Science、OpenGrey）的观察性研究，评估从数据库开始到 2020 年 1 月接受 LSS 手术的成人手术后步行的相关因素。两名审查员独立评估研究的资格、提取数据和评估偏倚风险（预后研究的质量）。建议分级评估、制定和评估方法用于确定每个因素的证据水平。结果 筛选了 5526 项研究的资格。纳入了 34 项研究（20 个队列，9,973 名参与者，26 项高偏倚风险，2 项中等偏倚风险，6 项低偏倚风险）。确定了 40 个变量（12 个可变）。中等质量的证据表明术前行走能力与术后行走能力呈正相关。脊椎滑脱的存在和狭窄的严重程度与术后行走能力无关。调查的所有其他因素的证据水平很低/非常低。结论 更大的术前行走与更大的术后行走能力相关，但与脊椎滑脱或狭窄的严重程度无关。很少有研究调查了可能针对优化手术结果的可变预后因素。