Open AccessFactors associated with lumbar spinal stenosis in a large-scale, population-based cohort: The Wakayama Spine Study
Author(s) -
Takahiro Maeda,
Hiroshi Hashizume,
Nagahisa Yoshimura,
Hiroyuki Oka,
Yuyu Ishimoto,
Keiji Nagata,
Masanari Takami,
Shunji Tsutsui,
Hiroshi Iwasaki,
Akihito Minamide,
Yukihiro Nakagawa,
Yasutsugu Yukawa,
Shigeyuki Muraki,
Sakae Tanaka,
Hiroshi Yamada,
Munehito Yoshida
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0200208
Subject(s) - medicine , lumbar spinal stenosis , spinal stenosis , odds ratio , body mass index , confidence interval , stenosis , logistic regression , anthropometry , population , orthopedic surgery , cross sectional study , physical therapy , surgery , lumbar , pathology , environmental health
Objective Patients with lumbar spinal stenosis (LSS) who have radiographically similar degrees of stenosis may not necessarily exhibit equivalent symptoms. As part of a cross-sectional study, we examined factors associated with symptomatic LSS (sLSS) in the general population of Japan. Methods We evaluated 968 participants (men, 319; women, 649) between 2008 and 2010. Orthopedic surgery specialists diagnosed sLSS using interview results, medical examinations, and imaging findings. LSS was radiographically graded using a 4-level scale. Additionally, we examined basic anthropometry, smoking habits, alcohol consumption, ankle-brachial index values (ABI), and glycosylated hemoglobin (HbA1c) levels. We grouped patients with moderate and severe radiographic LSS, and compared the indicated factors on the basis of the presence/absence of sLSS. Data were evaluated using multiple logistic regression analyses. Results Radiographically, 451 participants had moderate and 288 severe stenosis. Clinically, 92 participants were diagnosed with sLSS, including 36 with moderate and 52 with severe stenosis. In the moderate stenosis group, participants with sLSS had significantly higher rates of diabetes mellitus (DM) and lower ABIs than did non-LSS participants. Although sLSS participants tended to be older (p = 0.19), there were no significant differences in the sex distribution, body mass index values, or in the percentages of participants who were drinkers/smokers. In the severe stenosis group, there were no differences in any of the evaluated factors. Multiple logistic regression showed that DM (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.52–9.34]) and low ABI (1 SD = 0.09; OR, 1.36; 95% CI, 1.04–1.81) were significantly associated with LSS in the moderate stenosis group. Conclusions DM and low ABIs are significantly associated with sLSS in patients with moderate radiographic stenosis. Neither factor is associated with sLSS in patients with severe stenosis. Notably, the effects of intrinsic factors on symptomology may be masked when anatomic stenosis is severe.