Objective: Prolonged waiting times for spinal clinics necessitate efficient referral pathways. Symptomatic lumbar stenosis is a common reason for referral. We investigated the relationship between pre operative patient reported outcome measures (PROMs) and post operative score difference (POSD).

Methods: A retrospective review of Oswestry Disability Index (ODI) and EuroQol visual analogue scale (EQVAS) data was performed for patients who underwent single level lumbar decompression at our institution. One year POSD was calculated. Linear regression and multivariable analysis assessed the impact of baseline characteristics on POSD.

Results: Of 179 screened, 130 patients were analysed. Pre operative ODI and EQVAS strongly predicted POSD: β = –0.32 (95% CI –0.53 to –0.12; exp[β] = 0.73, 95% CI 0.59 to 0.89) and β = –0.76 (95% CI –0.94 to –0.57; exp[β] = 0.47, 95% CI 0.39 to 0.56), respectively (both p < 0.001). In univariate analysis, current smoking (vs. never) was associated with a larger reduction in EQVAS (β = –15.9, 95% CI –29.7 to –2.0; exp[β] = 1.3×10⁻⁷, p = 0.025), but this association did not persist after multivariable adjustment (p = 0.063). No other baseline characteristic (age, BMI, depression, diabetes, wait times, HbA1c) showed independent effects; all exponentiated confidence intervals included 1.0. A positive response to surgery was predicted at pre operative ODI >22 and EQVAS <60; a 50% probability of achieving the minimal clinically important difference occurred at ODI >52.4 and EQVAS <44.3.

Conclusions: Pre operative PROMs can guide referral thresholds. No baseline demographic independently predicted outcome, though larger studies are needed to detect small effects. These findings support incorporating PROMs into outpatient triage for single level lumbar stenosis.