Journal List > J Korean Orthop Assoc > v.51(5) > 1013466

Shin, Choi, Park, Kim, Kim, Kim, and Han: The Effect of Lumbar Spinal Stenosis on Results of Treatment in Peripheral Arterial Disease

Abstract

Purpose

The purpose of this study was to evaluate the result of percutaneous transluminal angioplasty (PTA) in patients with concurrent lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD).

Materials and Methods

Patients who underwent PTA for intermittent claudication were evaluated retrospectively. Twenty-two patients with severe LSS were included in group A and 23 patients with no or mild LSS in group B. The symptomatic improvement after PTA was comparatively evaluated.

Results

Visual analogue scale (VAS) and Walking Impairment Questionnaire (WIQ) scores showed significant improvement after PTA in both groups (p<0.001, <0.001). However, according to VAS, WIQ and modified MacNab scores, results of group A were less satisfactory (p<0.001, <0.001, p=0.03). Only 2 patients underwent additional spine surgery.

Conclusion

In results of PTA, the PAD associated LSS group showed less improvement than the PAD only group, but most patients showed symptomatic improvement with conservative treatment.

Figures and Tables

Figure 1

Severe lumbar spinal stenosis on T2-weighted axial image is defined when anterior cerebrospinal fluid space is obliterated and none of the cauda equina could be visually separated from each other, appearing as a bundle.

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Figure 2

Measurement of a cross-sectional area of the dural sac on computed tomography scan. A region of interest was drawn with a graphic cursor around the cross-sectional area of the dural sac and the area was calculated.

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Figure 3

A 65-year-old male patient who had walking difficulty due to an intermittent cramping pain in the right lower leg. (A) T2-weighted axial magnetic resonance imaging shows severe central spinal stenosis at L4–5 level. (B) Computed tomography-angiography shows occlusion of the right superficial femoral artery (arrow). (C) Balloon angioplasty was performed. (D) Final angiography shows restoration of blood flow without residual stenosis.

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Figure 4

70-year-old female patient who suffered from both leg claudication. (A) T2-weighted axial magnetic resonance image shows severe central spinal stenosis at L4–5 level. (B) Angiography shows occlusion in the right superficial femoral artery. (C) Percutaneous transluminal angioplasty (PTA) was performed. (D) Final angiography. Even though PTA was successful technically, the patient complained of residual buttock and leg pain. (E) After posterior fusion L4–5, claudication was relieved.

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Table 1

Scoring Scheme Used for the Diagnosis Support Tool for LSS

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Patients with a total score of ≥7 were considered to have lumbar spinal stenosis (LSS).

Table 2

Patient Characteristics between Two Groups

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Values are presented as mean±standard deviation or number only. Data were analyzed by Student's t-test and chi-square test. p-values of <0.05 were considered statistically significant.*Group of patients with severe lumbar spinal stenosis (LSS). Group of patients with no LSS or mild LSS. ABI, ankle-brachial index; LSS, lumbar spinal stenosis; DM, diabetes mellitus; HTN, hypertension; IHD, ischemic heart disease.

Table 3

VAS and WIQ Scores of Patients in Groups A* and B

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Values are presented as mean±standard deviation. Data were analyzed by Student's t-test. p-values of <0.05 were considered statistically significant.*Group of patients with severe lumbar spinal stenosis (LSS). Group of patients with no LSS or mild LSS. PTA, percutaneous transluminal angioplasty; VAS, visual analogue scale; WIQ, Walking Impairment Questionnaire; F/U, follow-up.

Table 4

Modified MacNab Scores of Patients in Groups A* and B

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VData were analyzed by chi-square test (p=0.03).*Group of patients with severe lumbar spinal stenosis (LSS). Group of patients with no LSS or mild LSS.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose

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