Abstract
BackgroundThe pathological mechanisms of lumbar spinal stenosis are unclear. Family doctors in the primary care setting may perform medical examinations of patients with lumbar spinal stenosis. Our aim was to use the painDETECT questionnaire to quantify the pathological mechanisms of low back pain and/or leg pain caused by lumbar spinal stenosis.MethodsWe enrolled 102 patients (37 men, 65 women) who had been newly diagnosed with lumbar spinal stenosis at 2 facilities. The patients’ conditions were evaluated using the painDETECT questionnaire, Numerical Rating Scale, Roland-Morris Disability Questionnaire, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, and 36-Item Short-Form Health Survey. The pathological mechanisms of low back pain and/or leg pain caused by lumbar spinal stenosis were classified based on results of the painDETECT questionnaire as nociceptive pain, neuropathic pain, or unclear type of pain (mixed pain). Statistical analyses were performed using the Kruskal–Wallis test. A value of p < 0.05 was considered to indicate statistical significance.ResultsThe mean age of all patients in this study was 70.3 ± 2 years. The male:female distribution was 37:65 (36.3:63.7 %). In all, 72 (70.6 %) patients had chronic pain (duration of ≥3 months), and 30 (29.4 %) had subacute or acute pain (duration of <3 months). The pain was classified as nociceptive in 59 patients (57.9 %), neuropathic in 18 (17.6 %), and unclear in 25 (24.5 %). The neuropathic pain group had a significantly lower quality of life (p < 0.05) than did the other groups.ConclusionsPatients with neuropathic back and/or leg pain caused by lumbar spinal stenosis may have lower physical and/or psychological quality of life than patients with such pain caused by other mechanisms.
Highlights
The pathological mechanisms of lumbar spinal stenosis are unclear
The magnetic resonance imaging (MRI) diagnosis of Lumbar spinal stenosis (LSS) was based on the following findings: (1) blockage of cerebrospinal fluid and/or the disappearance of fatty tissue surrounding the foramen on T1-weighted images in the sagittal view; (2) central stenosis, lateral recess stenosis, and/or foraminal stenosis caused by lumbar disc compression from the front, and/or increased size of the ligamentum flavum, and/or articular factors from the back in the axial view; and/or (3) compression of the nerve root surrounding the foramen in the coronal view
The demographic and clinical characteristics of the patients with low back pain (LBP) and/ or leg pain caused by LSS were similar among the three pain subgroups
Summary
The pathological mechanisms of lumbar spinal stenosis are unclear. Family doctors in the primary care setting may perform medical examinations of patients with lumbar spinal stenosis. Doctors in the primary care setting may perform medical examinations of patients with LSS. The characteristic symptom of LSS is neurogenic intermittent claudication (NIC) [5, 6], other symptoms may appear as well, including low back pain (LBP), radicular pain and/or numbness down the leg, and motor weakness in the legs [7,8,9,10].
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