Abstract
BackgroundLumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication. Differentiation between both origins can be difficult and characteristics such as symptom manifestations, time to relief in rest position and pain localization should be considered when determining diagnosis and the treatment plan. The objectives of this study were to compare changes in walking time to symptom change during treadmill tests and self-reported outcomes measures related to claudication, kinesophobia and global health between individuals with LSS, PAD and non-specific low back pain (nLBP).MethodFifty-five patients (23 with LSS, 14 with PAD and 18 with nLBP) were recruited from May 2018 to March 2020 to complete a treadmill walking test involving two 5-min walking tasks (Upright and Forward Leaning Trunk (FLT) Walking tasks). The speed was set at 1.9 km/h (1.2 mph), and each task was followed by a 5-min rest period. Walking time to symptom change and Total walking time were recorded during each walking task. Patients were asked to complete four questionnaires related to the impact of claudication, walking impairment, kinesiophobia and global health. One-way ANOVAs were performed to compare walking time difference from the Upright to the FLT walking tasks and to compare questionnaires results between groups.ResultsOne-way ANOVAs showed a significant difference between groups regarding difference in Walking time to symptom change between both tasks (F = 4.12, p = 0.022). The LSS group improved its Walking time to symptom change from the Upright to the FLT walking tasks more than the PAD (p = 0.34) and the nLBP group (p = 0.12). The nLBP group was less impacted by claudication and less impaired during walking compared to the LSS and PAD groups (ps < 0.001). The nLBP group also had less kinesiophobia than the LSS one (p < 0.001), but was similar to the PAD group. The global health rating was not statistically different between groups (p = 0.118).ConclusionThe test was able to distinguish neurogenic from vascular or nLBP related claudication. However, further studies are needed to validate this new treadmill walking test.Trial registrationclinicaltrials.gov (NCT04058171), Registered August 15, 2019 –Registered during recruitment
Highlights
Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication
The one-way Analysis of variance (ANOVA) showed a significant between-group difference for age (p < 0.001) and the Tukey post hoc analysis showed that patients were younger in the non-specific low back pain (nLBP) group compared to the LSS (p < 0.001) and PAD groups (p < 0.001)
Post hoc analysis showed that participants from the LSS group increased their walking time to symptom change from the Upright position to the Forward lean trunk position compared to the PAD group (p = 0.034) and the nLBP group (p = 0.012)
Summary
Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication. Vascular claudication is a common manifestation in individuals with peripheral arterial disease (PAD), while neurogenic claudication occurs in lumbar musculoskeletal disorders with neurological involvement such as specific low back pain (LBP) conditions One of these specific LBP conditions causing neurogenic claudication is lumbar spinal stenosis (LSS). Peripheral arterial disease is a condition affecting the blood vessels caused by a narrowing of the arteries, usually brought on by the accumulation of atheroma plates (atherosclerosis) [1] This accumulation leads to insufficient blood supply to the muscles which is accentuated with increasing intensity of activities such as walking [7]. When PAD patients are walking the need in oxygen increases in muscles and the insufficient blood supply leads to pain into the leg(s) and subsequently to the need to stop or to sit to relieve the pain
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