Lumbar Spinal Stenosis and Financial Hardship: A Patient-Centered Analysis from A Middle-Income Country

Original Article

Abstract

Objective: To evaluate the economic burden of Lumbar Spinal Stenosis (LSS) and to identify the contributing factors.

Methodology: This Cross-sectional Study was conducted in the Department of Neurosurgery, MMC/BKMCMardan, from January to June 2025. We recruited a consecutive sample of 100 adult patients diagnosed with radiologically and clinically proven lumbar spinal stenosis. We used a questionnaire to collect data on demographics, family income, treatment cost, transport cost, income loss, treatment delay, and self-reported financial hardship. We categorized financial hardship as mild (<25% of monthly household income), moderate (25–50%), and severe (>50%).

Results: Among 100 patients, 58% were male and 42% female, with a mean age of 56.8 ± 11.4 years. Forty-seven percent of participants reported severe financial hardship, 32% moderate hardship, and 21% mild hardship. Patients with severe stenosis incurred significantly higher treatment costs than those with mild-to-moderate disease (PKR 68,500 ± 18,200 vs. PKR 39,700 ± 14,600; p = 0.002). Severe hardship was more common among unemployed/daily wage earners (63.4% vs. 28.7%; p = 0.001), rural residents (p = 0.004), and surgically managed patients (74.2% vs. 39.5%; p < 0.001). Household income inversely correlated with financial toxicity (r = –0.48, p < 0.001).

Conclusion: Financial hardship is prevalent among patients with Lumbar Spinal Stenosis in middle-income countries and is closely linked to the severity of symptoms, rural living, low income, and surgery. Financial support and better access to spinal care may help alleviate this.