An Arterial Pulse Examination Is Not Sufficient for Diagnosis of Peripheral Arterial Disease in Lumbar Spinal Canal Stenosis: A Prospective Multicenter Study

Prospective, multicenter study. To conduct peripheral arterial disease (PAD) screening on intermittent claudication (IC) in patients with lumbar spinal canal stenosis (LSCS) to examine the relationships among combined LSCS and PAD, symptoms, and physical findings. IC occurs due to two underlying dis...

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Bibliographic Details
Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2011-07, Vol.36 (15), p.1204-1210
Main Authors: IMAGAMA, Shiro, MATSUYAMA, Yukihiro, KANEMURA, Tokumi, KATO, Fumihiko, YUKAWA, Yasutsugu, YOSHIDA, Toru, HARADA, Atsushi, KAWAKAMI, Noriaki, SUZUKI, Kazuhiro, MATSUBARA, Yuji, GOTO, Manabu, SATO, Koji, SAKAI, Yoshihito, ITO, Shigehiko, MARUYAMA, Koji, YANASE, Makoto, ISHIDA, Yoshihiro, KUNO, Naoto, HASEGAWA, Takao, ISHIGURO, Naoki, ITO, Zenya, WAKAO, Norimitsu, DEGUCHI, Masao, HACHIYA, Yudo, OSAWA, Yoshimitsu, YOSHIHARA, Hisatake, KAMIYA, Mitsuhiro
Format: Article
Language:English
Subjects:
Ankle Brachial Index
Biological and medical sciences
Brachial Artery - physiopathology
Cerebrospinal fluid. Meninges. Spinal cord
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Drug Therapy - methods
Humans
Intermittent Claudication - diagnosis
Intermittent Claudication - physiopathology
Intermittent Claudication - therapy
Lumbar Vertebrae
Medical sciences
Nervous system (semeiology, syndromes)
Neurology
Orthopedic Procedures - methods
Peripheral Arterial Disease - diagnosis
Peripheral Arterial Disease - physiopathology
Peripheral Arterial Disease - therapy
Prospective Studies
Pulse
Risk Factors
Spinal Canal - pathology
Spinal Stenosis - physiopathology
Spinal Stenosis - therapy
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Summary:Prospective, multicenter study. To conduct peripheral arterial disease (PAD) screening on intermittent claudication (IC) in patients with lumbar spinal canal stenosis (LSCS) to examine the relationships among combined LSCS and PAD, symptoms, and physical findings. IC occurs due to two underlying diseases, LSCS and PAD, and has an increasing prevalence with the aging of society. Reliable diagnosis of PAD is critical for appropriate conservative management of IC patients with LSCS in an Orthopedic Surgery Outpatient Department (OSOPD). PAD tests were prospectively conducted in 201 patients with IC and LSCS who initially visited an OSOPD at a hospital affiliated with the Nogoya Spine Group. Occurrence of PAD as a complication was assessed using ankle brachial pressure index (ABI) and toe brachial pressure index (TBI) tests. PAD was diagnosed in patients with ABI ≤ 0.9 or TBI ≤ 0.6, and the relationship of the occurrence of PAD with symptoms and physical findings such as abnormal arterial pulses was investigated. Combined LSCS and PAD was found in 52 patients (26%), with 45 cases (22%) diagnosed on the basis of TBI test in patients with a normal ABI. Of the patients with PAD, many suffered from risk factors for PAD, with a significantly higher frequency of PAD in patients with hyperlipidemia (P < 0.05). PAD also occurred significantly more frequently in patients with abnormal pulses in the popliteal (P < 0.05), posterior tibial (P < 0.0001), and dorsal pedis (P < 0.0001) arteries; however, the sensitivity of these tests for PAD diagnosis was relatively low, at 34%, 60% and 68%, respectively. The results of the prospective study define the rate of occurrence of combined LSCS and PAD using ABI and TBI tests for the first time, and the findings suggest that screening for PAD should be conducted in LSCS patients. ABI and TBI tests are necessary for PAD screening in outpatients, whereas observation of the arterial pulse in the lower extremities is necessary but not sufficient for PAD diagnosis.
ISSN:0362-2436
1528-1159
DOI:10.1097/BRS.0b013e3181ebd86f