Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?

Suri, Pradeep; Rainville, James; Kalichman, Leonid; Katz, Jeffrey N.

doi:10.1001/jama.2010.1833

Cited by 178 publications

(181 citation statements)

References 37 publications

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“…Although the approach from Hall et al 10 is not designed to make specific inference to a patho-anatomical source of pain, these patients present with extension dominant LBP and/or neurogenic claudication and essentially represent symptomatic facet osteoarthritis (OA). 10,[21][22][23][24] This group represents a growing demographic and accounted for 41% of this cohort.…”

Section: Discussionmentioning

confidence: 99%

The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

et al. 2015

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Section: Discussionmentioning

confidence: 99%

The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

et al. 2015

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“…14,31,32,37 Essentially, these patients present with unilateral or bilateral neurogenic claudication symptoms, much like patients with LSS. 38 Two studies using these selection cri ter ia have directly assessed the outcome of D alone for DLS compared with LSS patients without DLS. Sasai and colleagues 37 demonstrated that the outcomes of midline facet-preserving D in select patients with DLS (n = 23) was similar to those of patients with LSS (n = 25) without spondylolisthesis at a minimum of 2 years (mean follow-up was 4 yr).…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study

Rampersaud

Fisher

Yee

et al. 2014

cjs

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Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study Background: Decompression alone (D) is a well-accepted treatment for patients with lumbar spinal stenosis (LSS) causing neurogenic claudication; however, D is controversial in patients with LSS who have degenerative spondylolisthesis (DLS). Our goal was to compare the outcome of anatomy-preserving D with decompression and fusion (DF) for patients with grade I DLS. We compared patients with DLS who had elective primary 1-2 level spinal D at 1 centre with a cohort who had 1-2 level spinal DF at 5 other centres. Methods:Patients followed for at least 2 years were included. Primary analysis included comparison of change in SF-36 physical component summary (PCS) scores and the proportion of patients achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Results:There was no significant difference in baseline SF-36 scores between the groups. The average change in PCS score was 10.4 versus 11.4 (p = 0.61) for the D and DF groups, respectively. Sixty-seven percent of the D group and 71% of the DF group attained MCID, while 64% of both D and DF groups attained SCB. There was no significant difference between D and DF for change in PCS score (p = 0.74) or likelihood of reaching MCID (p = 0.81) or SCB (p = 0.85) after adjusting for other variables. Conclusion:In select patients with DLS, the outcome of D is comparable to DF at a minimum of 2 years.Contexte : La décompression seule est un traitement bien accepté pour la sténose lombaire (SL) causant une claudication neurogène. Son utilisation ne fait cependant pas l'unanimité chez les patients atteints de SL qui souffrent d'un spondylolisthésis dégénératif (SLD). Notre objectif était de comparer l'issue d'une décompression avec préservation anatomique à celle d'une décompression-arthrodèse (DA) chez des patients atteints de SLD de grade 1. Nous avons comparé les patients atteints de SLD ayant subi une décompression élective primaire de niveau 1-2 dans un centre à une cohorte ayant subi une DA de niveau 1-2 effectuée dans 5 autres centres.Méthodes : Nous avons inclus les patients qui ont été suivis pendant au moins 2 ans. L'analyse primaire comportait une comparaison des changements aux scores sommaires pour la composante physique (CP) du questionnaire SF-36 et la proportion de patients ayant obtenu une différence minimale cliniquement importante (DMCI) et en ayant tiré un bienfait clinique substantiel (BCS). Résultats :Il n'y avait pas de différence significative entre les scores SF-36 des 2 groupes au départ. Le changement moyen du score pour la CP a été de 10,4 c. 11,4 (p = 0,61) dans les groupes soumis à la décompression et à la DA, respectivement. Soixante-sept pour cent des patients du groupe soumis à la décompression et 71 % du groupe soumis à la DA ont obtenu une DMCI, tandis que 64 % des 2 groupes ont obtenu un BCS. On n'a noté aucune différence significative entr...

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“…4 The study population was not limited to patients with specific reports of intermittent claudication; rather, patients presenting with LBP and/or lower extremity pain were included. The meta-analysis concluded that the symptoms most commonly associated with LSS were absence of pain when seated, improvement of symptoms when bending forward and presence of bilateral buttock or leg pain.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Two common pathologies produce intermittent claudication: lumbar spinal stenosis (LSS) resulting in "intermittent neurogenic claudication" (sometimes referred to as LSS syndrome) and peripheral vascular disease (PVD) leading to "intermittent vascular claudication." Although both produce activity-limiting symptoms in the legs, the pathogenesis of each differs.…”

mentioning

confidence: 99%

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation

Nadeau

Rosas‐Arellano

Gurr

et al. 2013

CJS

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Background: Intermittent claudication can be neurogenic or vascular. Physicians use a profile based on symptom attributes to differentiate the 2 types of claudication, and this guides their investigations for diagnosis of the underlying pathology. We evaluated the validity of these symptom attributes in differentiating neurogenic from vascular claudication. Methods:Patients with a diagnosis of lumbar spinal stenosis (LSS) or peripheral vascular disease (PVD) who reported claudication answered 14 questions characterizing their symptoms. We determined the sensitivity, specificity and positive and negative likelihood ratios (PLR and NLR) for neurogenic and vascular claudication for each symptom attribute. Results:We studied 53 patients. The most sensitive symptom attribute to rule out LSS was the absence of "triggering of pain with standing alone" (sensitivity 0.97, NLR 0.050). Pain alleviators and symptom location data showed a weak clinical significance for LSS and PVD. Constellation of symptoms yielded the strongest associations: patients with a positive shopping cart sign whose symptoms were located above the knees, triggered with standing alone and relieved with sitting had a strong likelihood of neurogenic claudication (PLR 13). Patients with symptoms in the calf that were relieved with standing alone had a strong likelihood of vascular claudication (PLR 20.0). Conclusion:The classic symptom attributes used to differentiate neurogenic from vascular claudication are at best weakly valid independently. However, certain constellation of symptoms are much more indicative of etiology. These results can guide general practitioners in their evaluation of and investigation for claudication.Contexte : La claudication intermittente peut avoir une étiologie neurogène ou vasculaire. Les médecins utilisent un profil fondé sur les particularités des symptômes pour distinguer l'une de l'autre et ceci oriente leur choix des méthodes de diagnostic de la pathologie sous-jacente. Nous avons évalué la validité de ces particularités des symptômes utilisées pour distinguer la claudication d'origine neurogène de la claudication d'origine vasculaire. Méthodes :Des patients atteints d'une sténose spinale lombaire (SSL) ou d'une maladie vasculaire périphérique (MVP) avérées qui se plaignaient de claudication ont répondu à 14 questions afin de caractériser leurs symptômes. Nous avons déterminé la sensibilité, la spécificité et les rapports de probabilité positifs et négatifs (RPP et RPN) à l'égard de la claudication neurogène ou vasculaire pour chacune des particularités des symptômes.Résultats : Notre étude a regroupé 53 patients. La particularité des symptômes dotée de la sensibilité la plus élevée pour ce qui est d'écarter le diagnostic de SSL a été l'absence de « déclenchement de la douleur à la simple station debout » (sensibilité 0,97; RPN 0,050). Les données sur ce qui soulageait la douleur et sur la localisation des symptômes ont eu une faible portée clinique en ce qui a trait à la SSL et à la MVP. La présence d'une constellati...

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Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?

Cited by 178 publications

References 37 publications

The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation

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