Spinal stenosis prevalence and association with symptoms: the Framingham Study

Abstract

Background context The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear. Purpose To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP. Study design/setting Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study. Patient sample A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study. Outcome measures Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12 mm for relative LSS and 10 mm for absolute LSS. Methods Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index. Results In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05–9.53). Conclusions The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP.