SPINE Volume 38, Number 9, pp E554–E561 ©2013, Lippincott Williams & Wilkins
EPIDEMIOLOGY
Socioeconomic and Physical Characteristics of Individuals With Degenerative Lumbar Spinal Stenosis Janan Abbas, MSc,*† Kamal Hamoud, MD, MCh(Orth),‡ Hila May, MSc,* Nathan Peled, MD,§ Rachel Sarig, DMD, PhD,* Dan Stein, MSC,* Deborah Alperovitch-Najemson, PhD,* and Israel Hershkovitz, PhD*
Study Design. A descriptive study of the association between demographic factors, and physical characteristics, and degenerative lumbar spinal stenosis (DLSS). Objective. To shed light on the association between socioeconomic parameters, physical characteristics, and DLSS. Summary of Background Data. Lumbar spinal stenosis is a prevalent and disabling condition in the aging population. DLSS is considered to be the most common type and is essentially associated with disc disease, facet joint arthrosis, ligamentum flavum thickening, and osteophyte formation. Although there is ample information regarding the association between body mass index, cardiovascular disorders, smoking habits, and disc disease, very little is known about their association with DLSS. Data on the association of body physique (e.g., height and weight) and DLSS are limited. Methods. Two sample populations were studied. The first included 165 individuals with DLSS (mean age, 64 ± 9.9 yr) and the second 180 individuals without spinal stenosis related symptoms (mean age, 62.5 ± 12.6 yr). An evaluation of the cross-sectional area of the dural sac and degenerative listhesis for all participants was performed using computed tomographic lumbar spine images, obtained by Philips EBW station (Brilliance 64, Philips Medical System, Cleveland, OH). All participants were interviewed to obtain demographic, physical, and health data. Independent t test, Mann-Whitney and χ2 tests were used to determine the association between parametric and From the *Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; †Department of Physical Therapy, Zefat Academic College, Zefat, Israel; ‡Department of Orthopedic Surgery, Poria Medical Center, Tiberias, Israel; and §Department of Radiology, Carmel Medical Center, Haifa, Israel. Acknowledgment date: July 18, 2012. First revision date: November 17, 2012. Second revision date: January 10, 2013. Acceptance date: January 28, 2013. The manuscript submitted does not contain information about medical device(s)/drug(s). The Dan David Foundation, the Tassia and Dr. Joseph Meychan Chair of History and Philosophy of Medicine, and the Israel Science Foundation (ISF: 1397/08) funds were received to support this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Janan Abbas, MSc, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; E-mail: [email protected] DOI: 10.1097/BRS.0b013e31828a2846
E554
nonparametric variables and DLSS. Logistic regression analysis was carried out to reveal predicting variables for DLSS. Results. Females with stenosis were significantly heavier and shorter than their counterparts in the control group. We also noticed that they delivered babies more often than those in the control group. Prevalence of individuals experiencing diabetes mellitus was significantly higher in the males with stenosis than control group. In the stenosis group, the frequencies of individuals engaged in heavy manual labor (males) and housekeeping (females) were significantly higher than that of their counterparts in the control group. Conclusion. Heavy manual labor and diabetes mellitus in males and housekeeping (females) play major roles in the genesis of DLSS. Key words: degenerative lumbar spinal stenosis (DLSS), body mass index (BMI), occupations, number of deliveries, diabetes mellitus. Spine 2013;38:E554–E561
L
umbar spinal stenosis (LSS) is a prevalent and disabling condition in the aging population.1,2 Today, it is the most common diagnosis associated with lumbar spine surgery in this population.3,4 An estimated 13% to 14% of individuals, who seek help from a specialist for low back pain (LBP), are diagnosed with LSS.5–7 LSS often results in substantial physical burden and is associated with significant health care costs.4,5,8 LSS is a clinical condition associated with claudication and low back pain.9,10 It can be either congenital (developmental) or acquired.11 The acquired type is considered to be the more common type,12 and it usually arises in an advanced age (>65 yr). It is essentially associated with degenerative changes of the 3-joint complex, ligamentum flavum thickening, and osteophyte formation.13–16 Although many studies have shown relationships between body mass index (BMI), cardiovascular disorders, and smoking habits with degenerative disc disease and low back pain,17–23 only limited information exists in regard to the association between these parameters and degenerative lumbar spinal stenosis (DLSS). Similarly, data on the association between body characteristics (e.g., height and weight) and body history (number of deliveries) with DLSS is scarce. The aim of this study was to reveal the association between body characteristics (weight, height, BMI), occupation, morbidity, smoking habit, and number of deliveries and DLSS.
www.spinejournal.com
April 2013
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. BRS205492.indd E554
23/03/13 9:04 AM
EPIDEMIOLOGY
Socioeconomic and Physical Characteristics of Degenerative LSS • Abbas et al
Figure 2. Evaluation of DS. DS was considered positive when the amount of listhesis exceeded 3 mm. DS indicates degenerative spondylolisthesis.
Figure 1. Measurement of cross-sectional area of dural sac.
MATERIALS AND METHODS Study Groups Two groups were studied: a control group and a group diagnosed with DLSS. The DLSS group included 165 individuals (age range: 40–88 yr; sex ratio: 80 male [M]/85 female [F]), who were consecutively enrolled and interviewed by a spine surgeon (K.H.) from 2006 to 2010. All had intermittent claudication accompanied with other symptoms related to spinal stenosis (LBP, radicular referred pain).24–26 The computed tomographic (CT) scans of all individuals were interpreted by the same surgeon and all manifested a reduced cross-sectional area of dural sac (
EPIDEMIOLOGY
Socioeconomic and Physical Characteristics of Individuals With Degenerative Lumbar Spinal Stenosis Janan Abbas, MSc,*† Kamal Hamoud, MD, MCh(Orth),‡ Hila May, MSc,* Nathan Peled, MD,§ Rachel Sarig, DMD, PhD,* Dan Stein, MSC,* Deborah Alperovitch-Najemson, PhD,* and Israel Hershkovitz, PhD*
Study Design. A descriptive study of the association between demographic factors, and physical characteristics, and degenerative lumbar spinal stenosis (DLSS). Objective. To shed light on the association between socioeconomic parameters, physical characteristics, and DLSS. Summary of Background Data. Lumbar spinal stenosis is a prevalent and disabling condition in the aging population. DLSS is considered to be the most common type and is essentially associated with disc disease, facet joint arthrosis, ligamentum flavum thickening, and osteophyte formation. Although there is ample information regarding the association between body mass index, cardiovascular disorders, smoking habits, and disc disease, very little is known about their association with DLSS. Data on the association of body physique (e.g., height and weight) and DLSS are limited. Methods. Two sample populations were studied. The first included 165 individuals with DLSS (mean age, 64 ± 9.9 yr) and the second 180 individuals without spinal stenosis related symptoms (mean age, 62.5 ± 12.6 yr). An evaluation of the cross-sectional area of the dural sac and degenerative listhesis for all participants was performed using computed tomographic lumbar spine images, obtained by Philips EBW station (Brilliance 64, Philips Medical System, Cleveland, OH). All participants were interviewed to obtain demographic, physical, and health data. Independent t test, Mann-Whitney and χ2 tests were used to determine the association between parametric and From the *Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; †Department of Physical Therapy, Zefat Academic College, Zefat, Israel; ‡Department of Orthopedic Surgery, Poria Medical Center, Tiberias, Israel; and §Department of Radiology, Carmel Medical Center, Haifa, Israel. Acknowledgment date: July 18, 2012. First revision date: November 17, 2012. Second revision date: January 10, 2013. Acceptance date: January 28, 2013. The manuscript submitted does not contain information about medical device(s)/drug(s). The Dan David Foundation, the Tassia and Dr. Joseph Meychan Chair of History and Philosophy of Medicine, and the Israel Science Foundation (ISF: 1397/08) funds were received to support this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Janan Abbas, MSc, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; E-mail: [email protected] DOI: 10.1097/BRS.0b013e31828a2846
E554
nonparametric variables and DLSS. Logistic regression analysis was carried out to reveal predicting variables for DLSS. Results. Females with stenosis were significantly heavier and shorter than their counterparts in the control group. We also noticed that they delivered babies more often than those in the control group. Prevalence of individuals experiencing diabetes mellitus was significantly higher in the males with stenosis than control group. In the stenosis group, the frequencies of individuals engaged in heavy manual labor (males) and housekeeping (females) were significantly higher than that of their counterparts in the control group. Conclusion. Heavy manual labor and diabetes mellitus in males and housekeeping (females) play major roles in the genesis of DLSS. Key words: degenerative lumbar spinal stenosis (DLSS), body mass index (BMI), occupations, number of deliveries, diabetes mellitus. Spine 2013;38:E554–E561
L
umbar spinal stenosis (LSS) is a prevalent and disabling condition in the aging population.1,2 Today, it is the most common diagnosis associated with lumbar spine surgery in this population.3,4 An estimated 13% to 14% of individuals, who seek help from a specialist for low back pain (LBP), are diagnosed with LSS.5–7 LSS often results in substantial physical burden and is associated with significant health care costs.4,5,8 LSS is a clinical condition associated with claudication and low back pain.9,10 It can be either congenital (developmental) or acquired.11 The acquired type is considered to be the more common type,12 and it usually arises in an advanced age (>65 yr). It is essentially associated with degenerative changes of the 3-joint complex, ligamentum flavum thickening, and osteophyte formation.13–16 Although many studies have shown relationships between body mass index (BMI), cardiovascular disorders, and smoking habits with degenerative disc disease and low back pain,17–23 only limited information exists in regard to the association between these parameters and degenerative lumbar spinal stenosis (DLSS). Similarly, data on the association between body characteristics (e.g., height and weight) and body history (number of deliveries) with DLSS is scarce. The aim of this study was to reveal the association between body characteristics (weight, height, BMI), occupation, morbidity, smoking habit, and number of deliveries and DLSS.
www.spinejournal.com
April 2013
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. BRS205492.indd E554
23/03/13 9:04 AM
EPIDEMIOLOGY
Socioeconomic and Physical Characteristics of Degenerative LSS • Abbas et al
Figure 2. Evaluation of DS. DS was considered positive when the amount of listhesis exceeded 3 mm. DS indicates degenerative spondylolisthesis.
Figure 1. Measurement of cross-sectional area of dural sac.
MATERIALS AND METHODS Study Groups Two groups were studied: a control group and a group diagnosed with DLSS. The DLSS group included 165 individuals (age range: 40–88 yr; sex ratio: 80 male [M]/85 female [F]), who were consecutively enrolled and interviewed by a spine surgeon (K.H.) from 2006 to 2010. All had intermittent claudication accompanied with other symptoms related to spinal stenosis (LBP, radicular referred pain).24–26 The computed tomographic (CT) scans of all individuals were interpreted by the same surgeon and all manifested a reduced cross-sectional area of dural sac (
