Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan.
Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, 45 Jyunibancho, Wakayama, 640-8158, Japan.
BMC Musculoskelet Disord. 2022 Sep 12;23(1):857. doi: 10.1186/s12891-022-05810-y.
Although lumbar spinal stenosis (LSS) often coexists with other degenerative conditions, few studies have fully assessed possible contributing factors for low back pain (LBP) in patients with LSS. The purpose of this study was to identify factors associated with the severity of LBP in patients with LSS.
The patients with neurogenic claudication caused by LSS, which was confirmed by magnetic resonance imaging (MRI) were included in this cross-sectional study. Data included ratings of LBP, buttock and leg pain, and numbness on a numerical rating scale (NRS), 36-item Short-Form Survey (SF-36) scores, muscle mass measured by bioelectrical impedance analysis, and radiographic measurements including lumbopelvic alignment and slippage. The severity of LSS, endplate defects, Modic endplate changes, intervertebral disc degeneration, and facet joint osteoarthritis were evaluated on MRI. Spearman correlation and multivariate linear regression analyses were used to examine the factors associated with the severity of LBP (NRS score).
A total of 293 patients (135 male and 158 female, average age 72.6 years) were analyzed. LBP was moderately correlated with buttock and leg pain, and buttock and leg numbness. Significant but weak correlations were observed between LBP and body mass index, appendicular and trunk muscle mass, all domains of SF-36, pelvic tilt, total number of endplate defects and Modic endplate changes, and summary score of disc degeneration grading, but not severity or number of spinal stenoses. In the multivariate regression analysis, age, female sex, trunk muscle mass, diabetes, NRS buttock and leg pain, NRS buttock and leg numbness, SF-36 vitality, pelvic tilt, and total number of endplate defects were associated with the severity of LBP.
Trunk muscle mass, lumbopelvic alignment, and endplate defects, but not severity of stenosis are partly associated with severity of LBP, but buttock and leg pain and buttock and leg numbness have strongest relationships with LBP in patients with LSS.
腰椎管狭窄症（LSS）常与其他退行性疾病并存，但很少有研究充分评估 LSS 患者腰痛（LBP）的可能致病因素。本研究旨在确定与 LSS 患者 LBP 严重程度相关的因素。
本横断面研究纳入了经磁共振成像（MRI）证实的神经源性间歇性跛行患者。数据包括腰痛、臀部和腿部疼痛以及麻木的数字评分量表（NRS）评分、36 项简短健康调查（SF-36）评分、生物电阻抗分析测量的肌肉质量，以及包括腰椎骨盆排列和滑移在内的影像学测量。MRI 评估 LSS 严重程度、终板缺陷、Modic 终板改变、椎间盘退变和小关节骨关节炎。采用 Spearman 相关分析和多元线性回归分析评估与 LBP 严重程度（NRS 评分）相关的因素。
共分析了 293 名患者（男 135 名，女 158 名，平均年龄 72.6 岁）。LBP 与臀部和腿部疼痛以及臀部和腿部麻木中度相关。LBP 与体重指数、四肢和躯干肌肉质量、SF-36 所有领域、骨盆倾斜、终板缺陷总数和 Modic 终板改变以及椎间盘退变分级综合评分呈显著但较弱的相关性，但与狭窄严重程度或数量无相关性。多元回归分析显示，年龄、女性、躯干肌肉质量、糖尿病、NRS 臀部和腿部疼痛、NRS 臀部和腿部麻木、SF-36 活力、骨盆倾斜和终板缺陷总数与 LBP 严重程度相关。
躯干肌肉质量、腰椎骨盆排列和终板缺陷与 LBP 严重程度部分相关，但在 LSS 患者中，臀部和腿部疼痛以及臀部和腿部麻木与 LBP 关系最为密切。
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