Clinical StudySpinal stenosis prevalence and association with symptoms: the Framingham Study
Introduction
Despite the fact that lumbar spinal stenosis (LSS) is one of the most commonly diagnosed and treated pathologic conditions affecting the spine, very little is known about the epidemiology of stenosis in the general population. The prevalence of acquired, so-called “degenerative” lumbar stenosis has been suggested as ranging from 1.7% to 13.1% [1], [2], [3]. However, previously reported studies have used asymptomatic populations or selected clinical populations undergoing imaging studies for other reasons. Furthermore, the methods of LSS evaluation were often not described or inappropriate. There have been no prevalence rates reported in unselected populations. Given the increasing use of diagnostic imaging, the unclear association of spinal stenosis radiographic findings with symptoms, and the fact that spinal stenosis is one of the most common indications for spinal surgery, a clear understanding of the prevalence of spinal stenosis in the community and its association with symptoms is greatly needed.
One major difficulty in performing any epidemiologic analysis is the absence of universally accepted diagnostic criteria for spinal stenosis [4]. Magnetic resonance imaging (MRI) and computed tomography (CT) are the most frequently used diagnostic modalities in clinical practice, but strict measurements defining the presence of clinically significant canal, subarticular, or foraminal narrowing do not exist. The concept that overall rates of spinal stenosis reflect the relative contribution of two distinct types of stenosis, congenital (or developmental) and acquired (or degenerative), is however generally acknowledged [5].
Recognizing these limitations, the aims of the present study were 1) to evaluate the prevalence of congenital and acquired radiographic spinal stenosis in an unselected community-based population and 2) to evaluate the association between spinal stenosis observed on CT and the risk of experiencing low back pain (LBP).
Section snippets
Study design
The design used is a cross-sectional study.
Sample
This study was an ancillary project to the Framingham Heart Study. The Framingham Heart Study began in 1948 as a longitudinal population-based cohort study of the causes of heart disease. Initially, 5,209 men and women between the ages of 30 and 60 years living in Framingham, MA were enrolled. Biennial examinations were conducted by trained research staff at the study clinic located in Framingham. In 1971, 5,124 offspring (and their spouses) of the
Results
The study sample included 191 study participants, 104 (55.6%) males and 87 (44.4%) females. The mean age was 52.6±10.8 (age range: 32–79 years) and the mean BMI was 27.8±5.0. This subsample was representative of the whole group of individuals who underwent multidetector CT scanning (N=3,590). The percent of males in whole sample was 51.8%, mean age 52.7±11.8, and mean BMI 27.8±5.3. The comparison tests showed that there was no difference between the whole sample and the subsample studied here
Discussion
Although LSS is one of the most commonly diagnosed spinal disorders, is the major reason for surgery in older adults [18], and is considered a major cause of pain and disability, little is known regarding the epidemiology of this condition. This is the first cross-sectional study to describe the prevalence of radiographic LSS in a community-based population. There are few previously published reports that include any estimate of the population prevalence of LSS. De Villiers and Booysen [1] in a
Conclusions
The prevalence of congenital LSS in the US community-based sample is 4.71% and 2.62% for relative and absolute stenosis, respectively. The prevalence of relative and absolute acquired stenosis increases with age to 47.2% and 19.4%, respectively, in the 60- to 69-year-old age group. The very high prevalence of stenosis in the general population aged older than 60 years warns against attributing pain and neurological symptoms in this patient population to LSS based solely on the appearance of
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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.