Spinal stenosis prevalence and association with symptoms: the Framingham Study
Received 8 August 2008; accepted 12 March 2009. published online 24 April 2009.
Abstract
Background context
The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear.
Purpose
To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP.
Study design/setting
Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study.
Patient sample
A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study.
Outcome measures
Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS.
Methods
Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index.
Results
In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05–9.53).
Conclusions
The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP.
aClinical Epidemiology Research and Training Unit, Boston University, 650 Albany Street (X Building), Suite 200, Boston, MA 02118, USA
bDivision of Research, Boston University School of Medicine, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA
cDepartment of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA
dDepartment of Radiology, Boston University School of Medicine, 820 Harrison Avenue, Boston, MA 02118, USA
Corresponding author. Division of Research, Boston University School of Medicine, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA. Tel.: (617) 754-6655; fax: (617) 754-5728.
FDA device/drug status: not applicable.
Author disclosures: LK (supported by an Arthritis Foundation Postdoctoral Grant); DJH (supported by a research grant from DonJoy, Wyeth, MERCK, Pfizer, Stryke, and Lilly); DHK (consulting fees from Medtronic, DePuy, Stryker, Zimmer, Syntle; research support for staff and materials from New England Baptist Hospital); and AG (stock ownership in Synarc Inc; office in a company, president, BICL, LLC).
This work was supported by the National Heart, Lung, and Blood Institute's Framingham Heart Study contract (No. N01-HC-25195) for the recruitment, enrollment, and examination of the Offspring and Third Generation cohort and the imaging by computed tomography scan.
ABSTRACT