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Symptoms of lumbar spinal stenosis in people with knee or hip osteoarthritis or low back pain

LSS

Goal of the Study?

In this exploratory cross-sectional study pre-proof article (prior to publication) to be published in the Journal of Osteoarthritis and Cartilage 1 the authors’ goals were twofold:

  • Report on the proportion of patients in a Danish OsteoArthritis (OA) primary care program that had knee OA, hip OA and persistent Lower Back Pain (LBP).
  • Identify what proportion of these 3 categories also had symptoms associated with Lumbar Spinal Stenosis (LSS)

 

Why are they doing this study?

Musculoskeletal comorbidities are common in people with back pain and OsteoArthritis (OA) and associated with increased disability.  Musculoskeletal comorbidities are also present in people with Lumbar Spinal Stenosis (LSS), a disabling low back condition primarily affecting older people.  Evidence suggests that LSS and knee and hip OA often occur.  In one Canadian study, 77% of patients undergoing surgical decompression for LSS reported knee and hip OA.  In a US study, clinically defined knee and hip OA was reported in 32% and 17% of LSS patients.  However, it is not known if symptoms associated with LSS are common in people with knee and hip OA in primary care programs.

What was done?

A total of 11,125 people with a primary complaint of persistent lower back pain and/or knee or hip OA from a registered in a Danish group-based education and exercise program called Good Life with osteoArthritis in Denmark (GLA:D®), were given a questionnaire to identify the symptoms of LSS.  Two sets of clinical criteria were used to build the self-reporting questionnaire; Tomkins-Lane Criteria and the Genevay Criteria. Both these LSS classification tools use clustering of symptoms of leg and buttock pain during a series of activities to define the level of LSS.

 

What did they find?

Despite the high prevalence of LSS symptoms in the 10,234 GLA:D patients surveyed, less than 10% were considered to have LSS by either the Tomkins-Lane or Geneway classification criteria.  When looking at the individual symptoms the prevalence of self-reported LSS symptoms varied greatly between the three cohorts; Knee OA, Hip OA and persistent LBP.  LSS symptoms of transient pain or numbness associated with the lower extremity items were found in 71% of patients with persistent LBP versus 50% for hip OA and 40% for knee OA.  This pattern was observed for all LSS symptoms except for numbness in the soles of both feet.  Only 10-11% of all three cohorts had this LSS symptom. 

 

Why do these findings matter?

Self-reported LSS symptoms are commonly reported by people treated in primary care for hip or knee OA, although not as frequently as those with persistent LBP. Despite symptoms of LSS being common, only a small percentage actually meet the Tomkins-Lane and/or Geneway clinical LSS threshold. 

 

At Dynamic Disc Designs we understand that topics related to osteoarthritis and stenosis are common in a clinical setting. Providing professionals with realistic modeling can be a time saver when these types of conversations comes up. We hope to help you build a solid, trustworthy, relationship with the patients you care for in a credible and evidence-based way.

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