J Korean Orthop Assoc.  2016 Oct;51(5):357-364. 10.4055/jkoa.2016.51.5.357.

The Effect of Lumbar Spinal Stenosis on Results of Treatment in Peripheral Arterial Disease

• Shin CS
• Choi BY
• Park SB
• Kim KT
• Kim TH
• Kim CS
• Han KD

• KMID: 2355499
• DOI: http://doi.org/10.4055/jkoa.2016.51.5.357

Abstract

PURPOSE
The purpose of this study was to evaluate the result of percutaneous transluminal angioplasty (PTA) in patients with concurrent lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD).
MATERIALS AND METHODS
Patients who underwent PTA for intermittent claudication were evaluated retrospectively. Twenty-two patients with severe LSS were included in group A and 23 patients with no or mild LSS in group B. The symptomatic improvement after PTA was comparatively evaluated.
RESULTS
Visual analogue scale (VAS) and Walking Impairment Questionnaire (WIQ) scores showed significant improvement after PTA in both groups (p<0.001, <0.001). However, according to VAS, WIQ and modified MacNab scores, results of group A were less satisfactory (p<0.001, <0.001, p=0.03). Only 2 patients underwent additional spine surgery.
CONCLUSION
In results of PTA, the PAD associated LSS group showed less improvement than the PAD only group, but most patients showed symptomatic improvement with conservative treatment.

Keyword

lumbar vertebrae; spinal stenosis; peripheral arterial disease; intermittent claudication; percutaneous transluminal angioplasty

MeSH Terms

Angioplasty
Humans
Intermittent Claudication
Lumbar Vertebrae
Peripheral Arterial Disease*
Retrospective Studies
Spinal Stenosis*
Spine
Walking

Figure

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  Figure 1 Severe lumbar spinal stenosis on T2-weighted axial image is defined when anterior cerebrospinal fluid space is obliterated and none of the cauda equina could be visually separated from each other, appearing as a bundle.

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  Figure 2 Measurement of a cross-sectional area of the dural sac on computed tomography scan. A region of interest was drawn with a graphic cursor around the cross-sectional area of the dural sac and the area was calculated.

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  Figure 3 A 65-year-old male patient who had walking difficulty due to an intermittent cramping pain in the right lower leg. (A) T2-weighted axial magnetic resonance imaging shows severe central spinal stenosis at L4–5 level. (B) Computed tomography-angiography shows occlusion of the right superficial femoral artery (arrow). (C) Balloon angioplasty was performed. (D) Final angiography shows restoration of blood flow without residual stenosis.

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  Figure 4 70-year-old female patient who suffered from both leg claudication. (A) T2-weighted axial magnetic resonance image shows severe central spinal stenosis at L4–5 level. (B) Angiography shows occlusion in the right superficial femoral artery. (C) Percutaneous transluminal angioplasty (PTA) was performed. (D) Final angiography. Even though PTA was successful technically, the patient complained of residual buttock and leg pain. (E) After posterior fusion L4–5, claudication was relieved.

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