1. 2013;16;513-520Clinical and Radiological Characteristics of Concomitant Peripheral Arterial Obstructive Disease in Patients with Lumbar Spinal Stenosis
   Cohort Assessment
   Seung-Hwan Han, MD, PhD, Chang-Hoon Jeon, MD, PhD, Doo-Hyung Lee, MD, Ho-Sik Choo, MD, and Nam-Su Chung, MD.

BACKGROUND:  Intermittent claudication is a typical symptom of lumbar spinal stenosis (LSS) and peripheral arterial obstructive disease (PAD). Because both LSS and PAD are predominantly associated with degenerative conditions, concomitant conditions are not uncommon. However, few reports of the demographic, clinical, and radiological characteristics of concomitant LSS and PAD (LSSPAD) have been published.

OBJECTIVE:  To identify the demographic, clinical, and radiological risk factors for concomitant PAD in LSS.

STUDY DESIGN: A retrospective matched-control study.

METHODS: This study involved a retrospective cohort of 43 consecutive patients with LSSPAD and a control cohort of 45 age- and gender-matched patients diagnosed with LSS without PAD. Each patient in both groups underwent plain lumbar radiographs, magnetic resonance imaging of the lumbar spine, and ankle-brachial index (ABI) measurement. Demographic and clinical parameters were obtained. The abdominal aorta calcification score (AACS) was evaluated on the lateral lumbar radiographs. Computed tomographic angiography (CTA) of the lower limb was performed to confirm PAD.

RESULTS: The mean age of the LSSPAD group was 67.7 ± 10.7 years (52 – 88 years). The prevalence of diabetes mellitus (DM) was significantly higher in the LSSPAD group than in the LSS group (P = 0.022). The mean ABI was 0.71 ± 0.22 (0.32 – 0.91) for the LSSPAD group and 0.96 ± 0.18 (0.83 – 1.10) for LSS group (P < 0.001). The prevalence of aortic calcification was significantly higher in the LSSPAD group than in the LSS group (P < 0.001). The mean AACS was 10.2 ± 3.2 (2 – 18) for the LSSPAD group and 3.4 ± 4.1 (0 – 14) for the LSS group (P < 0.001).

LIMITATIONS: Retrospective design.

CONCLUSION: We found that concomitant PAD in patients with LSS is associated with old age, DM, the presence of aortic calcification, and ABI < 0.9. When these risk factors exist, further work up is needed to exclude the concomitant PAD.