Lumbar spinal stenosis associated with peripheral arterial disease: a prospective multicenter observational study
Intermittent claudication is a common symptom of both lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) in middle-aged and elderly people. However, the prevalence and clinical characteristics of LSS with PAD (LSSPAD) have not been investigated in a multicenter study. The aim of this study was to investigate the prevalence and clinical characteristics of LSS associated with PAD.
570 patients diagnosed with LSS using a clinical diagnostic support tool and MRI at 64 facilities were enrolled. We evaluated each patient’s medical history, physical findings, ankle brachial index, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score, and the Short Form 36 (SF-36) score. Statistical analyses were performed to compare LSSPAD patients and LSS patients without PAD using the t test, Mann–Whitney’s U test, and multivariate recurrence analysis. p values of <0.05 were considered statistically significant.
The LSSPAD group comprised 38 patients (6.7 %); 20 (3.5 %) had pre-diagnosised PAD while 18 (3.2 %) had undetected PAD. The clinical characteristics of these patients were advanced age, diabetes, and a history of ischemic heart disease and cerebrovascular disorder. 570 patients enrolled, and 448 (78.6 %) of those patients were followed up at three months after enrollment. Pain in buttocks and legs improved less in the LSSPAD group than in the LSS group (p < 0.05). Improvements in the “general health” score in SF-36 were lower in the LSSPAD group than in the LSS group (p < 0.05).
Advanced age, diabetes, and a history of cerebrovascular disorder and ischemic heart disease were associated with LSSPAD. Because LSSPAD patients show less improvement in QOL than patients with LSS but without PAD do, clinicians should consider the coexistence of PAD in LSS patients.
- Thome C, Borm W, Meyer F. Degenerative lumbar spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105:373–9.
- Watters WC 3rd, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2008;8:305–10.
- Takahashi K, Miyazaki T, Takino T, Matsui T, Tomita K. Epidural pressure measurements. Relationship between epidural pressure and posture in patients with lumbar spinal stenosis. Spine. 1995;20:650–3. CrossRef
- Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White J, White RA, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)—summary of recommendations. J Vasc Interv Radiol. 2006;17:1383–97.
- Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5–67. CrossRef
- Diehm N, Dick F, Czuprin C, Lawall H, Baumgartner I, Diehm C. Oscillometric measurement of ankle-brachial index in patients with suspected peripheral disease: comparison with Doppler method. Swiss Med Wkly. 2009;139:357–63.
- Heald CL, Fowkes FGR, Murray GD, Price JF. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atherosclerosis 2006;189:61–9.
- Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR. Howard BV. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004;109:733–9.
- Dodge LD, Bohlman HH, Rhodes RS. Concurrent lumbar spinal stenosis and peripheral vascular disease. A report of nine patients. Clin Orthop Relat Res. 1988;230:141–8.
- Konno S, Hayashino Y, Fukuhara S, Kikuchi S, Kaneda K, Seichi A, Chiba K, Satomi K, Nagata K, Kawai S. Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis. Eur Spine J. 2007;16:1951–7. CrossRef
- Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease? JAMA. 2006;295:536–46. CrossRef
- Diehm C, Lange S, Darius H, Pittrow D, von Stritzky B, Tepohl G, Haberl RL, Allenberg JR, Dasch B. Association of low ankle brachial index with high mortality in primary care. Eur Heart J. 2006;27:1743–9. CrossRef
- Guo X, Li J, Pang W, Zhao M, Luo Y, Sun Y, Hu D. Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries. Circ J. 2008;72:605–10. CrossRef
- Ouriel K. Peripheral arterial disease. Lancet. 2001;358:1257–64. CrossRef
- Bernstein EF, Fronek A. Current status of noninvasive tests in the diagnosis of peripheral arterial disease. Surg Clin North Am. 1982;62:473–87.
- Beckman JA, Higgins CO, Gerhard-Herman M. Automated oscillometric determination of the ankle-brachial index provides accuracy necessary for office practice. Hypertension. 2006;47:35–8. CrossRef
- Benchimol A, Bernard V, Pillois X, Hong NT, Benchimol D, Bonnet J. Validation of a new method of detecting peripheral artery disease by determination of ankle-brachial index using an automatic blood pressure device. Angiology. 2004;55:127–34.
- Mitsuru F, Kazuhiro C, Mamoru K, Shinichi K, Shinichi K, Masabumi M, Atsushi S, Tadashi S, Osamu S, Toshihiko T, Kazuhisa T, Katsushi T, Toshikazu T. JOA back pain evaluation questionnaire: initial report. J Orthop Sci. 2007;12:443–50.
- Fukuhara S, Suzukamo Y. Manual of SF-36v2 Japanese version. Kyoto: Institute for Health Outcomes & Process Evaluation Reseach; 2004.
- Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: the Rotterdam Study. Arterioscler Thromb Vasc Biol. 1998;18:185–92. CrossRef
- Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation. 2004;110:738–43. CrossRef
- Alzamora MT, Fores R, Baena-Diez JM, Pera G, Toran P, Sorribes M, Vicheto M, Reina MD, Sancho A, Albaladejo C, Llussa J. The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health. 2010;10:38. CrossRef
- Blanes JI, Cairols MA, Marrugat J. Prevalence of peripheral artery disease and its associated risk factors in Spain: The ESTIME Study. Int Angiol. 2009;28:20–5.
- Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, McDermott M. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317–24. CrossRef
- Hooi JD, Kester ADM, Stoffers HEJH, Rinkens PELM, van Knottnerus JA, Ree JW. Asymptomatic peripheral arterial occlusive disease predicted cardiovascular morbidity and mortality in a 7-year follow-up study. J Clin Epidemiol. 2004;57:294–300. CrossRef
- Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009;9:545–50.
- Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc. 1985;33:13–8.
- Robertson GS, Ristic CD, Bullen BR. The incidence of congenitally absent foot pulses. Ann R Coll Surg Engl. 1990;72:99–100.
- Hiatt WR, Marshall JA, Baxter J, Sandoval R, Hildebrandt W, Kahn LR, Hamman RF. Diagnostic methods for peripheral arterial disease in the San Luis Valley Diabetes Study. J Clin Epidemiol. 1990;43:597–606. CrossRef
- Lundin M, Wiksten JP, Perakyla T, Lindfors O, Savolainen H, Skytta J, Lepantalo M (1999) Distal pulse palpation: is it reliable? World J Surg. 1999;23:252–5.
- Lumbar spinal stenosis associated with peripheral arterial disease: a prospective multicenter observational study
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of Orthopaedic Science
Volume 17, Issue 6 , pp 673-681
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Author Affiliations
- 1. Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
- 2. Spine Center, Hakodate Central General Hospital, Hakodate, Japan
- 3. Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
- 4. Department of Orthopedic Surgery, Keio University, Tokyo, Japan
- 5. Department of Orthopedic Surgery, Kobe University, Kobe, Japan
- 6. Department of Orthopedic Surgery, Koseiren Takaoka Hospital, Takaoka City, Japan
- 7. Matsuo Vascular Ultrasound Laboratory, Matsuo Clinic, Osaka, Japan
- 8. Department of Orthopedic Surgery, Osaka Minami Medical Center, Osaka, Japan
- 9. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan