Lai Marcus Kin Long, Cheung Prudence Wing Hang, Samartzis Dino, Karppinen Jaro, Cheung Kenneth Man Chee, Cheung Jason Pui Yin
Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Bone Joint J. 2021 Jan;103-B(1):131-140. doi: 10.1302/0301-620X.103B1.BJJ-2020-1186.R2.
To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability.
This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions.
Subjects with DSS had higher prevalence of radicular leg pain, more pain-related disability, and lower quality of life (all p < 0.05). Subjects with DSS had 1.5 (95% confidence interval (CI) 1.0 to 2.1; p = 0.027) and 1.8 (95% CI 1.3 to 2.6; p = 0.001) times higher odds of having radicular leg pain in the past month and the past year, respectively. However, DSS was not associated with LBP. Although, subjects with a spondylolisthesis had 1.7 (95% CI 1.1 to 2.5; p = 0.011) and 2.0 (95% CI 1.2 to 3.2; p = 0.008) times greater odds to experience LBP in the past month and the past year, respectively.
This large-scale study identified DSS as a risk factor of acute and chronic radicular leg pain. DSS was seen in 6.9% of the study cohort and these patients had narrower spinal canals. Subjects with DSS had earlier onset of symptoms, more severe radicular leg pain, which lasted for longer and were more likely to have worse disability and poorer quality of life. In these patients there is an increased likelihood of nerve root compression due to a pre-existing narrowed canal, which is important when planning surgery as patients are likely to require multi-level decompression surgery. Cite this article: 2021;103-B(1):131-140.
研究腰椎发育性椎管狭窄（DSS）与腰痛（LBP）、神经根性腿痛及功能障碍之间的关联。
这是一项对2206名受试者进行的横断面研究，同时进行了L1 - S1节段的轴向和矢状面MRI检查。评估了他们的人口统计学、工作量、吸烟习惯、椎管前后径、椎体滑脱及MRI变化等临床和放射学信息。采用曼 - 惠特尼U检验和卡方检验来寻找有无DSS的受试者之间的差异。还通过单因素和多因素逻辑回归分析了MRI检查后1个月（30天）和1年（365天）内报告的LBP和神经根性疼痛与临床和放射学信息之间的关联。
患有DSS的受试者神经根性腿痛的患病率更高，与疼痛相关的功能障碍更多，生活质量更低（均p < 0.05）。患有DSS的受试者在过去1个月和过去1年出现神经根性腿痛的几率分别高1.5倍（95%置信区间（CI）1.0至2.1；p = 0.027）和1.8倍（95%CI 1.3至2.6；p = 0.001）。然而，DSS与LBP无关。尽管如此，患有椎体滑脱的受试者在过去1个月和过去1年经历LBP的几率分别高1.7倍（95%CI 1.1至2.5；p = 0.011）和2.0倍（95%CI 1.2至3.2；p = 0.008）。
这项大规模研究确定DSS是急性和慢性神经根性腿痛的一个危险因素。在研究队列中，6.9%的受试者存在DSS，这些患者的椎管更狭窄。患有DSS的受试者症状出现更早，神经根性腿痛更严重，持续时间更长，更有可能出现更严重的功能障碍和更低的生活质量。在这些患者中，由于预先存在的椎管狭窄，神经根受压的可能性增加，这在计划手术时很重要，因为患者可能需要进行多节段减压手术。引用本文：2021;103 - B(1):131 - 140。
