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

Abstract

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.

Concomitant Occlusive Vascular Lesions of Legs in Patients with Degenerative Lumbar Diseases: Do These Lesions Influence Treatment?

“…Although claudication and leg pain are very common symptoms of lumbar degenerative disease, such as central stenosis, foraminal stenosis, and spondylolisthesis, these symptoms also occur in patients with peripheral arterial disease of the legs. 3,7,10 Therefore, a differential diagnosis of vascular claudication is important for the treatment. 1 Screening for concomitant vascular lesion of the legs is essential to avoid any unnecessary spine operations.…”

“…A significant finding of the ABPI ratio is < 0.9, according to the previous guideline for the management of patients with peripheral artery disease. 3,4,6,9 If peripheral arterial occlusive lesions were suspected on ultrasound, computed tomography angiography (CTA) of the lower extremities was performed (►Fig. 1).…”

“…Patients with lumbar degenerative diseases, such as spinal stenosis, herniated disk, and degenerative spondylolisthesis, develop pain in their legs and intermittent claudication. [1][2][3] Lumbar degenerative diseases and occlusive vascular lesions may present similar symptoms in the lower extremities. 1,4 Narrowing or obstruction of vessels can decrease blood flow to the lower limbs, causing pain and claudication of the legs.…”

“…1,4 Narrowing or obstruction of vessels can decrease blood flow to the lower limbs, causing pain and claudication of the legs. 3,4 Symptoms related to occlusive vascular lesions of the lower limbs range from intermittent claudication to pain at rest. 5 Narrowing or occlusion of arteries of the lower limbs may produce pain in the buttocks, thighs, and legs.…”

“…6 Thus these symptoms of vascular lesions may be confused with those of lumbar radiculopathy. 3,5,7 A spine surgeon may overlook occlusive arterial disease of the legs in patients with lumbar degenerative disease including central canal stenosis, foraminal stenosis, and spondylolisthesis. Although the incidence of vascular claudication is very low, overlooking occlusive vascular lesions can lead to unnecessary spine surgery.…”