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Waiting for lumbar spinal stenosis surgery: suffering, resources to cope and expectations
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Department of Nursing, Mid Sweden University.
Department of Surgical and Perioperative Science, Umeå University.
Department of Research and Development, Vasternorrland County Council and Karolinska Institutet, NVS, Division of Neurorehabilitation, Stockholm .
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective To describe the experience of being a person with LSS and how life and suffering are managed under the influence of their disease.

Methods/design/setting A Swedish county hospital. Interviews with 18 consecutive patients on the waiting list for LSS surgery. The themes that emerged from content analysis were further interpreted using Antonovsky salutogenic model as a sensitizing concept. 


Six themes emerged from the analysis, revealed that living with LSS is a physical, mental and social challenge in which resources to cope with the condition are of major importance.


Conclusion Being a patient with LSS includes suffering, but also to be a person with own resources to cope with the suffering, or having support structures for doing so. Both physicians and patients need to work towards a salutogenic perspective, focusing on resources to improve care, making it more comprehensible, manageable and meaningful.

Keyword [en]
Antonovsky, coping, low back pain, lumbar, patient-perspective, patient-centered, patient-physician relationship, qualitative study, salutogenesis, sciatica, spinal stenosis, spine surgery, suffering
Keyword [sv]
Antonovsky, ischias, kvalitativ studie, lidande, patientperspektiv, ryggkirurgi, ryggsmärta, rygg, Salutogenes, spinal stenos
National Category
Other Medical Sciences not elsewhere specified
Research subject
URN: urn:nbn:se:uu:diva-264587OAI: oai:DiVA.org:uu-264587DiVA: diva2:861056
Available from: 2015-10-15 Created: 2015-10-15 Last updated: 2015-11-10
In thesis
1. Lumbar spinal stenosis: Body mass index and the patient's perspective
Open this publication in new window or tab >>Lumbar spinal stenosis: Body mass index and the patient's perspective
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During recent decades, lumbar spinal stenosis (LSS) has become the most common indication for spine surgery, a change that coincides with a higher worldwide prevalence of overweight and obesity. Thus, surgical treatment of LSS in the overweight and obese population is common and increasing in scope.

The overall aim of this thesis was to investigate whether body mass index (BMI) is related to the development of LSS, and whether BMI is linked to outcome after surgery for LSS. We further evaluated whether there are specific experiences of LSS from a patient perspective.

Data were obtained for all patients registered in the Swedish Spine Register who had undergone surgery for LSS between January 1, 2006 and June 30, 2008. After adjusting for differences in baseline characteristics, patients with obesity showed both poorer results after surgery and a higher rate of dissatisfaction than patients with normal weight (odds ratio 1.73; 95% confidence interval, CI, 1.36-2.19).

Furthermore, patients with obesity in the cohort reported modest weight loss at follow-up (2.0 kg; 95% CI, 1.5-2.4), and only 8% reported a clinical important weight loss 2 years after surgery.

Our analysis of 389,132 construction workers, showed that overweight (incidence rate ratio, IRR 1.68; 95% CI, 1.54-1.83) and obesity (IRR 2.18; 95% CI, 1.87-2.53) were associated with an increased future risk in developing LSS when compared with patients with normal weight.

To gain insight into the patients' perspective of LSS, we performed interviews with 18 patients who were on a waiting list for LSS surgery. The transcripts, analyzed with content analysis, revealed that living with LSS is a physical, mental and social challenge in which resources to cope with the condition are of major importance.

In summary, obesity is associated with poorer results after surgery, and patients with obesity report modest weight loss during follow-up. In addition, obesity is associated with an increased risk to develop LSS. Our findings revealed that being a patient with LSS, naturally involves considerable suffering and pain, but it also implies being a person with his or her own resources who is able to cope with these adverse conditions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 70 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1148
Antonovsky, back pain, BMI, body mass index, Bygghalsan, cohort study, coping, EQ-5D, excess weight, leg pain, LSS, lumbar spinal stenosis, obesity, ODI Oswestry disability index, overweight, patient-centered, patient-physician relationship, patient-perspective, patient-related-outcome-measure, PROMs, qualitative study, spinal stenosis, salutogenesis, salutogenic, sciatica, spine surgery, suffering, Swedish spine register, Swespine, VAS, weight loss, weight change
National Category
Research subject
urn:nbn:se:uu:diva-264589 (URN)978-91-554-9376-9 (ISBN)
Public defence
2015-12-04, Rosénsalen, Akademiska barnsjukhuset, ingång 95-96, 751 85, Uppsala, 13:00 (Swedish)
Available from: 2015-11-06 Created: 2015-10-15 Last updated: 2016-04-20

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