An Arterial Pulse Examination Is Not Sufficient for Diagnosis of Peripheral Arterial Disease in Lumbar Spinal Canal Stenosis

Imagama, Shiro; Matsuyama, Yukihiro; Sakai, Yoshihito; Ito, Zenya; Wakao, Norimitsu; Deguchi, Masashi; Y, Hachiya; Osawa, Yusuke; Yoshihara, Hisatake; Kamiya, Mitsuhiro; Kanemura, Tokumi; Kato, Fumihiko; Yukawa, Yasutsugu; Yoshida, Tôru; Harada, Atsushi; Kawakami, Noriaki; Suzuki, Kazuhiro; Matsubara, Yumiko; Goto, Manabu; Sato, Koji; Ito, Shigehiko; Maruyama, Koji; Yanase, Makoto; Ishida, Yoshihiro; Kuno, Naoto; Hasegawa, Takao; Ishiguro, Naoki

doi:10.1097/brs.0b013e3181ebd86f

Cited by 20 publications

(15 citation statements)

References 29 publications

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“…However, PAD is often misdiagnosed in older patients with LSS because it is difficult to distinguish vascular IC from neurogenic IC. Therefore, spine surgeons often overlook the possibility of PAD in patients with severe LSS 18) . In a previous study, the coincidence of PAD with LSS was similar to the prevalence of PAD in older individuals (6.7%) 27) .…”

Section: Discussionmentioning

confidence: 99%

“…To establish a screening test for PAD, ankle-brachial index (ABI) is commonly used. In previous reports, ABI has been found to be highly sensitive and specific for PAD screening 10 , 18 , 20 , 23 , 24) .…”

Section: Introductionmentioning

confidence: 91%

“…Several authors have reported PAD in patients with LSS 9 , 18 , 19 , 27) . Those reports presented the incidence of and risk factors for PAD in patients with LSS with atypical symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors and Incidence for Peripheral Arterial Disease in Patients with Typical Lumbar Spinal Stenosis

et al. 2014

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ObjectiveIntermittent claudication (IC) is a typical symptom of peripheral arterial disease (PAD) and lumbar spinal stenosis (LSS). In order to prevent misdiagnosis of vascular disease, it is important to know the incidence of and risk factors for PAD in patients with LSS. Therefore, the aim of our study was to evaluate the incidence of and risk factors for PAD in patients with typical and severe LSS who underwent spinal surgical treatment.MethodsThe occurrence of PAD was examined retrospectively in 171 consecutive patients with LSS and severe IC who underwent surgical treatment at our hospital from June 2012 to June 2013. Data were collected on background characteristics (sex, age) and known risk factors for PAD, such as hypertension, diabetes mellitus, smoking, hyperlipidemia, stroke, and ischemic heart disease.ResultsOf the 171 patients enrolled, 7 had an abnormal ankle-brachial index (ABI). Computed tomography angiography (CTA) was performed in these patients, and a final diagnosis of PAD was established for all 7 patients. The incidence of PAD in all patients with LSS was 4.1%(7 of 171). Stroke and ischemic heart disease were significantly more common in the LSSPAD group compared with the LSS group. Multiple logistic regression analyses with a forced-entry method revealed that age and stroke (p<0.05) were independent risk factors for PAD.ConclusionTo prevent misdiagnosis of fatal PAD, we recommend ABI be assessed in patients with LSS and history of stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

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Risk Factors and Incidence for Peripheral Arterial Disease in Patients with Typical Lumbar Spinal Stenosis

et al. 2014

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“…Reduced pulses at the foot and leg are a pathologic finding of vascular claudication, but the reliability and validity of pulse palpation are low [21][22][23]. Alternatively, ABI can be useful either as a screening tool for the primary prevention of PAD or as a tool for monitoring the therapeutic efficacy in secondary prevention.…”

Section: Discussionmentioning

confidence: 99%

The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication

et al. 2011

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Purpose Claudication is a typical symptom of peripheral arterial disease (PAD) and lumbar spinal stenosis (LSS). Differential diagnosis of PAD and LSS is often difficult due to the subjective natures of symptoms and atypical signs. The authors aimed to determine the usefulness of ankle-brachial index (ABI) measurement for the differential diagnosis of PAD and LSS when the etiology of claudication is uncertain. Methods Forty-two consecutive patients who had been referred by spine surgeons to a lower extremity vascular surgeon for atypical claudication were retrospectively analyzed. Atypical claudication was defined as claudication not caused by PAD, as determined by clinical manifestations, or by LSS, as determined by MR imaging. A final diagnosis of PAD was established by CT angiography (CTA) and of LSS by excluding PAD. Diagnostic validity of ABI for PAD in atypical presentation was assessed. Results Sixty-two legs of 42 atypical claudication patients were analyzed. Mean patient age was 65.8 ± 8.2 years (38-85) and 29 (69.0%) had diabetes mellitus. Mean ABI was 0.73 ± 0.14 (0.53-0.94) in the PAD group and 0.92 ± 0.18 (0.52-1.10) in the LSS group (P \ 0.001). Of the 33 legs with a low ABI (ABI \ 0.9), 29 legs were diagnosed as true positives for PAD by CTA and 4 were false positives, and of the 29 legs with a high ABI, 5 were false negatives and 24 were true negatives. The sensitivity and specificity of ABI for the diagnosis of PAD in patients with atypical claudication were 85.3 and 85.7%, respectively, and its positive and negative predictive values were 87.9 and 82.8%. Conclusions ABI is a recommended screening test for the differential diagnosis of lower leg claudication when clinical symptoms are atypical.

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“…Particularly in older people, the clinical picture may be blurred by accompanying illnesses. For example, it has been reported that 26% of elderly patients with lumbar spinal stenosis also have peripheral arterial occlusive disease (PAOD) (8), and a comparable percentage suffers from coxarthrosis (9). Meanwhile, a study from the Far East suggests that 100% of over 70-yearold patients with lumbar stenosis have either osteoporosis or osteopenia, although this finding clearly cannot be directly applied to the Central European population without further study (10).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Degenerative Lumbar Spinal Stenosis in Older People

Kalff¹,

Ewald²,

Waschke³

et al. 2013

Deutsches Ärzteblatt International

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An Arterial Pulse Examination Is Not Sufficient for Diagnosis of Peripheral Arterial Disease in Lumbar Spinal Canal Stenosis

Cited by 20 publications

References 29 publications

Risk Factors and Incidence for Peripheral Arterial Disease in Patients with Typical Lumbar Spinal Stenosis

Risk Factors and Incidence for Peripheral Arterial Disease in Patients with Typical Lumbar Spinal Stenosis

The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication

Degenerative Lumbar Spinal Stenosis in Older People

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