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Concurrent lumbar spinal stenosis and peripheral vascular disease. A report of nine patients
L D Dodge1, H H Bohlman, R S Rhodes
1Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, University Hospital, Cleveland, Ohio.
Insights
Differentiating peripheral vascular disease and lumbar spinal stenosis causing claudication is challenging. This study found that persistent leg discomfort after surgery for either condition necessitates excluding a secondary cause.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Diagnostic Imaging
Background:
- Intermittent claudication can stem from peripheral vascular disease or lumbar spinal stenosis, often presenting similar symptoms.
- Distinguishing between these two etiologies is crucial for effective treatment and patient outcomes.
Purpose of the Study:
- To investigate the diagnostic challenges and management of patients with overlapping symptoms of peripheral vascular disease and lumbar spinal stenosis.
- To evaluate outcomes in patients undergoing surgical intervention for either condition.
Main Methods:
- Retrospective analysis of 172 patients with symptoms of claudication and confirmed lumbar spinal stenosis.
- Inclusion of nine patients diagnosed with concurrent peripheral vascular disease via ultrasonography and arteriography.
- Review of surgical interventions including laminectomy, spinal fusion, abdominal aortic aneurysm repair, and various vascular bypass grafts.
Main Results:
- All nine patients with peripheral vascular disease and lumbar spinal stenosis underwent spinal decompression surgery (laminectomy).
- Vascular interventions included aneurysm repair, bypass grafts, and lumbar sympathectomy.
- Post-surgical follow-up (average 5 years) showed paresthesia resolution but persistent, difficult-to-attribute cramping discomfort during walking.
Conclusions:
- Persistent claudication symptoms after lumbar spinal or vascular surgery warrant investigation for secondary contributing etiologies.
- Accurate diagnosis and exclusion of concurrent conditions are vital for managing patients with complex claudication.
Abstract:
Intermittent claudication from peripheral vascular disease is sometimes difficult to distinguish from neurogenic claudication secondary to lumbar spinal stenosis. Of 172 patients with symptoms of claudication and lumbar spinal stenosis proved by myelography or computed tomography (CT), nine had peripheral vascular disease identified with ultrasonography and arteriography. All of the nine patients had a laminectomy performed to decompress the narrow spinal canal, and two had an additional posterolateral fusion. Two patients were treated with an excision of their abdominal aortic aneurysm, while one of those patients later required a bypass graft for iliac stenosis. One patient had had an aortofemoral bypass graft, one a femoropopliteal graft, and one a lumbar sympathectomy. Follow-up study ranged from three to eight years, with an average of five years after their last surgical procedure. Paresthesias generally dissipated after the spinal surgery. The cramping-type discomfort associated with walking was not easily attributed either to vascular or a neurogenic etiology. Five patients had initial weakness, which invariably improved. A secondary etiology contributing to claudication must be excluded in those patients with persistent discomfort following previous lumbar spinal or vascular surgery for arterial insufficiency.