Are We Treating More Than Pain? Restless Legs Syndrome Outcomes After Lumbar Laminectomy for Radiculopathy

BACKGROUND AND OBJECTIVES: Lumbar laminectomy is routinely performed for neurogenic claudication and radicular pain from lumbosacral stenosis. Restless legs syndrome (RLS) causes nocturnal discomfort with sleep disruption and can coexist with lumbosacral radiculopathy. We evaluated whether laminectomy in patients with neurologist-diagnosed RLS and imaging-confirmed root compression is associated with RLS symptom resolution. METHODS: We performed a retrospective 1:1 propensity-matched cohort study (158 laminectomy, 158 nonoperative) with a prospectively assessed subset. The primary outcome was complete RLS resolution, defined as symptom absence and discontinuation of RLS pharmacotherapy. Secondary outcomes included International Restless Legs Scale (IRLS) scores, levodopa equivalent daily dose, Oswestry Disability Index, and pain recurrence in the surgical cohort. RESULTS: Complete RLS resolution occurred in 74% of surgical patients vs 23% of nonsurgical patients (risk ratio 3.16; P < .001). In the prospectively assessed subset, baseline IRLS was similar (25.0 ± 6.2 vs 24.0 ± 7.1), but follow-up scores were lower after laminectomy (6.0 ± 7.3 vs 17.0 ± 8.1; P < .001). A total of 78% vs 35% achieved ≥50% IRLS reduction. Levodopa equivalent daily dose decreased in surgical patients (140.0 ± 40.5 to 25.0 ± 45.8 mg/day) but increased in nonoperative patients (145.0 ± 45.7-153.0 ± 87.1 mg/day; P < .001). A total of 70% vs 24% discontinued dopaminergic therapy. Oswestry Disability Index improved more after laminectomy (mean change -13.6 ± 18.1 vs -5.9 ± 16.7; P < .001). Pain recurred in 29.1% of surgical patients. Lack of RLS resolution was associated with higher pain recurrence risk (hazard ratio 2.06; 95% CI 1.13-3.77). CONCLUSION: In patients with RLS and lumbosacral root compression, laminectomy was associated with improvements in RLS symptoms, decreased medication burden, and durability of pain relief, in addition to its conventional analgesic benefits. RLS symptom burden may represent an under-recognized dimension of outcome in spine surgery and supports routine RLS assessment when considering decompression.