Visually Assessed Severity of Lumbar Spinal Canal Stenosis Is Paradoxically Associated With Leg Pain and Objective Walking Ability

Pekka Kuittinen; Petri Sipola; Tapani Saari; Timo Juhani Aalto; Sanna Sinikallio; Sakari Savolainen; Heikki Kröger; Veli Turunen; Ville Leinonen; Olavi Airaksinen

Disclosures

BMC Musculoskelet Disord. 2014;15(348)

Conclusions

Association between the anatomical degree of LSS and the clinical findings is a complex one. Our findings indicate that advanced degenerative hypertrophy may potentially be a protective mechanism that causes relief of patient symptoms. Follow-up studies are needed to confirm if symptoms of patients with LSS may improve despite the progression of the anatomical degree of central LSS.

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Competing interests
The authors report no declarations of interests.

Authors' contributions
Guarantors of integrity of entire study, OA, HK; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; literature research, PK, PS, VL, TA; clinical studies, TA, SS, TS; statistical analysis, PK, VL, PS; and manuscript editing, all authors.

Acknowledgments
The first author wishes to thank the Kuopio University Hospital for the EVO research grant as well as the Finnish Cultural Foundation. The 9th author wishes to thank the Kuopio University Hospital for EVO research grant, Emil Aaltonen Foundation and the Finnish Medical Foundation. The study design was reviewed and approved by the Ethics Committee of University of Eastern Finland, Kuopio, Finland and Kuopio University Hospital, Finland, and experiments were in compliance with Finnish law.

Table 1. Clinical characteristics of the study subjects
	All patients (n = 80)	Moderate stenosis (n = 36)	Severe stenosis (n = 44)	P-value
Male/female	35/45 (43/56)	18/18 (50/50)	17/27 (39/61)	0.308
Marital status married or co-habiting	52 (65)	25 (69.5)	27 (61.3)	0.762
Current smoker	17 (21.3)	10 (27.7)	7 (16.0)	0.345
Previous lumbar operation	11 (13)	6 (16.7)	5 (11.4)	0.248
Depressed³	17 (21)	6 (16.7)	11 (25.0)	0.365
Minimal dural sac area^†	56.1 (21.9)	72.1 (18.0)	43.0 (15.2)	0.000
Age	63.0 (11.0)	62.0 (11.6)	64.0 (10.8)	0.413
BMI (kg/m²)	29.6 (4.0)	29.5 (4.4)	29.8 (3.5)	0.746
Number of somatic diseases	5.3 (3.0)	5.6 (3.2)	5.1 (2.8)	0.445
ODI	44.7 (16.1)	45.4 (18.0)	44.1 (14.4)	0.731
VAS overall	33.3 (23.9)	34.6 (24.7)	31.9 (25.0)	0.523
NRS LBP	4.1 (2.6)	4.72 (2.6)	3.59 (2.4)	0.059
NRS LP	6.49 (2.6)	7.33 (2.29)	5.80 (2.72)	0.008
BDI score	10.4 (6.1)	9.78 (6.86)	10.93 (5.546)	0.233
Walking distance (m)	545 (445)	421 (431)	646 (436)	0.021
Foraminal stenosis (normal/moderate/severe)^§		53/39/8	55/36/9	0.971
Multilevel stenosis yes/no^§		53/47	70/30	0.104
Lumbar fusion yes^§		33	66	0.258

Note: Except where indicated, data are numbers of patients, with percentages in parentheses or means, ± standard deviations in parentheses.
³BDI 15 or more points, ^†at the most stenotic level, mean (mm²), ± standard deviations in parentheses. ODI = Oswestry Disability Index (0–100), VAS overall = Visual analog pain scale (0–100), NRS LBP = Numerical rating scale low back pain at rest, scale (0–10), NRS LP = Numerical rating scale leg pain at walking, scale (0–10), BDI = Beck Depression Inventory (0–63), ^§Percentages.

Table 2. Correlation of the dural sac area with patient symptoms and walking capacity
	ODI scale	VAS overall scale	NRS LBP	NRS LP	Beck depression index	Treadmill test
Central spinal canal (mm2)	r = 0.086	r = −0.036	r = −0.004	r = 0.023	r = −0.099	r = −0.145
	P = 0.448	P = 0.752	P = 0.972	P = 0.841	P = 0.380	P = 0.200

r = Spearman correlation coefficients.
P = P values.
ODI = Oswestry Disability Index (0–100).
VAS overall = Visual analog pain scale (0–100).
NRS LBP = Numerical rating scale low back pain at rest (0–10).
NRS LP = Numerical rating scale leg pain at walking (0–10).
Treadmill exercise test (0–1000 m).
BDI = Beck Depression Inventory (0–63).