Factors associated with lumbar spinal stenosis in a large-scale, population-based cohort: The Wakayama Spine Study

PLoS One. 2018 Jul 18;13(7):e0200208. doi: 10.1371/journal.pone.0200208. eCollection 2018.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ankle Brachial Index
  • Diabetes Complications / epidemiology
  • Female
  • Humans
  • Japan / epidemiology
  • Lumbar Vertebrae / diagnostic imaging
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Spinal Stenosis / blood
  • Spinal Stenosis / diagnostic imaging
  • Spinal Stenosis / epidemiology*
  • Young Adult

Grants and funding

This study was supported by: H-25-Choujyu-007 (Director, Noriko Yoshimura), H25-Nanchitou (Men)-005 (Director, Sakae Tanaka), 201417014A (Director, Noriko Yoshimura), and H22-Choujyu-Wakate-007 (Director, Shigeyuki Muraki) from the Ministry of Health, Labor and Welfare (http://www.mhlw.go.jp); a Grant-in-Aid for Scientific Research (B26293139, B23390172 to Noriko Yoshimura, B2629333, C20591774 to Shigeyuki Muraki, C26462249 to Hiroshi Hashizume, C16K10834, C25462305 to Hiroshi Yamada); a Grant-in-Aid for Young Researchers (B25860448 to Yuyu Ishimoto); a Grant-in-Aid for Challenging Exploratory Research (15K15219 to Noriko Yoshimura, 26670307 to Shigeyuki Muraki, 24659666 to Hiroyuki Oka) of Japan Society for the Promotion of Science KAKENHI grant (https://www.jsps.go.jp/j- grantsinaid/); and Collaborating Research with NSF 08033011-00262 (Director, Noriko Yoshimura) from the Ministry of Education, Culture, Sports, Science and Technology in Japan (http://www.mext.go.jp/en/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.