Korean J Pain.  2021 Oct;34(4):471-478. 10.3344/kjp.2021.34.4.471.

The association between pain, balance, fall, and disability in patients with lumbar spinal stenosis with vascular claudication

• Güneş M
• Özmen T
• Güler TM

• KMID: 2520755
• DOI: http://doi.org/10.3344/kjp.2021.34.4.471

Abstract

Background
The effect of lumbar spinal stenosis (LSS) and peripheral vascular disease (PVD), which occurs with similar degenerative conditions, when seen together, has not been studied. The aim of this study is to examine and compare the relationship between pain, balance, disability, fear of falling, and kinesiophobia in LSS patients with intermittent vascular claudication (IVC).
Methods
Seventy-two patients diagnosed with LSS using magnetic resonance imaging participated in this study. Thirty-five patients with IVC symptoms and showing vascular lesions by lower extremity venous and arterial Doppler ultrasonography imaging were included in the IVC-LSS group. The pain, static balance, dynamic balance, disability, fear of falling, and kinesiophobia were evaluated using the numeric rating scale, single leg stance test, Time Up and Go (TUG), the Oswestry Disability Index (ODI), Fall Efficacy Scale-International (FES-I), and Tampa Scale for Kinesiophobia (TSK), respectively.
Results
Age and female sex were found to be higher in the IVC-LSS group (P = 0.024; P = 0.012). The IVC-LSS group had a shorter single leg stance time and TUG test duration, pain intensity, ODI, FES-I, and TSK scores were higher than patients with LSS (P = 0.001). Pain, fear of falling, and kinesiophobia were moderately correlated with disability in the IVC-LSS group. No relationship was found between pain and dynamic balance. Also, the pain was not related to kinesiophobia.
Conclusions
The findings indicated that IVC causes loss of balance and an increase in pain, disability, fear of falling, and kinesophobia in patients with LSS.

Keyword

Accidental Falls; Catastrophization; Disability Evaluation; Fear; Intermittent Claudication; Low Back Pain; Peripheral Vascular Diseases; Postural Balance; Spinal Stenosis; Ultrasonography; Doppler

Reference

1. Watters WC 3rd, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, et al. 2008; Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 8:305–10. DOI: 10.1016/j.spinee.2007.10.033. PMID: 18082461.

2. Van der Velden SK, Shadid NH, Nelemans PJ, Sommer A. 2014; How specific are venous symptoms for diagnosis of chronic venous disease? Phlebology. 29:580–6. DOI: 10.1177/0268355513515859. PMID: 24390751.

3. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. TASC II Working Group. 2007; Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 45 Suppl S:S5–67. DOI: 10.1016/j.jvs.2006.12.037. PMID: 17223489.

4. Han MH, Lee DH, Park KS, Lee YS, Kim KT, Sung JK, et al. 2014; Risk factors and incidence for peripheral arterial disease in patients with typical lumbar spinal stenosis. Korean J Spine. 11:183–7. DOI: 10.14245/kjs.2014.11.3.183. PMID: 25346766. PMCID: PMC4206957.

5. Messiah S, Tharian AR, Candido KD, Knezevic NN. 2019; Neurogenic claudication: a review of current understanding and treatment options. Curr Pain Headache Rep. 23:32. DOI: 10.1007/s11916-019-0769-x. PMID: 30888546.

6. Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK. 2019; A review of lumbar spinal stenosis with intermittent neurogenic claudication: disease and diagnosis. Pain Med. 20(Suppl 2):S32–44. DOI: 10.1093/pm/pnz161. PMID: 31808530. PMCID: PMC7101166.

7. Han SH, Jeon CH, Lee DH, Choo HS, Chung NS. 2013; Clinical and radiological characteristics of concomitant peripheral arterial obstructive disease in patients with lumbar spinal stenosis. Pain Physician. 16:513–20. DOI: 10.36076/ppj.2013/16/513. PMID: 24077197.

8. Uesugi K, Sekiguchi M, Kikuchi S, Kanayama M, Takahashi K, Chiba K, et al. 2012; Lumbar spinal stenosis associated with peripheral arterial disease: a prospective multicenter observational study. J Orthop Sci. 17:673–81. DOI: 10.1007/s00776-012-0311-z. PMID: 23053583. PMCID: PMC3513595.

9. Katz JN, Dalgas M, Stucki G, Lipson SJ. 1994; Diagnosis of lumbar spinal stenosis. Rheum Dis Clin North Am. 20:471–83. DOI: 10.1016/S0889-857X(21)00058-2. PMID: 8016421.

10. Truszczyńska A, Truszczyński O, Rąpała K, Gmitrzykowska E, Tranowski A. 2014; Postural stability disorders in rural patients with lumbar spinal stenosis. Ann Agric Environ Med. 21:179–82. PMID: 24738520.

11. Fortin M, Lazáry À, Varga PP, Battié MC. 2017; Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal stenosis. Eur Spine J. 26:2543–51. DOI: 10.1007/s00586-017-5228-y. PMID: 28748488.

12. van Wilgen CP, Stewart R, Patrick Stegeman PT, Coppes M, van Wijhe M. 2010; Fear of movement in pre-operative patients with a lumbar stenosis and or herniated disc: factor structure of the Tampa scale for kinesiophobia. Man Ther. 15:593–8. DOI: 10.1016/j.math.2010.07.002. PMID: 20705501.

13. Tomkins-Lane CC, Battié MC. 2013; Predictors of objectively measured walking capacity in people with degenerative lumbar spinal stenosis. J Back Musculoskelet Rehabil. 26:345–52. DOI: 10.3233/BMR-130390. PMID: 23948821.

14. Leinonen V, Määttä S, Taimela S, Herno A, Kankaanpää M, Partanen J, et al. 2002; Impaired lumbar movement perception in association with postural stability and motor- and somatosensory-evoked potentials in lumbar spinal stenosis. Spine (Phila Pa 1976). 27:975–83. DOI: 10.1097/00007632-200205010-00019. PMID: 11979174.

15. Iversen MD, Kale MK, Sullivan JT Jr. 2009; Pilot case control study of postural sway and balance performance in aging adults with degenerative lumbar spinal stenosis. J Geriatr Phys Ther. 32:15–21. DOI: 10.1519/00139143-200932010-00004. PMID: 19856631.

16. Truszczyńska A, Drzał-Grabiec J, Trzaskoma Z, Rąpała K, Tarnowski A, Górniak K. 2014; A comparative analysis of static balance between patients with lumbar spinal canal stenosis and asymptomatic participants. J Manipulative Physiol Ther. 37:696–701. DOI: 10.1016/j.jmpt.2014.09.003. PMID: 25267441.

17. Gardner AW, Montgomery PS. 2001; Impaired balance and higher prevalence of falls in subjects with intermittent claudication. J Gerontol A Biol Sci Med Sci. 56:M454–8. DOI: 10.1093/gerona/56.7.M454. PMID: 11445605.

18. Gohil RA, Mockford KA, Mazari F, Khan J, Vanicek N, Chetter IC, et al. 2013; Balance impairment, physical ability, and its link with disease severity in patients with intermittent claudication. Ann Vasc Surg. 27:68–74. DOI: 10.1016/j.avsg.2012.05.005. PMID: 23084732.

19. Lanzarin M, Parizoto P, Santos GM. 2016; Analysis of isokinetic muscle function and postural control in individuals with intermittent claudication. Braz J Phys Ther. 20:48–57. DOI: 10.1590/bjpt-rbf.2014.0134. PMID: 26786077. PMCID: PMC4835164.

20. Laghi Pasini F, Pastorelli M, Beermann U, de Candia S, Gallo S, Blardi P, et al. 1996; Peripheral neuropathy associated with ischemic vascular disease of the lower limbs. Angiology. 47:569–77. DOI: 10.1177/000331979604700605. PMID: 8678331.

21. Lane RA, Mazari F, Mockford KA, Vanicek N, Chetter IC, Coughlin PA. 2014; Fear of falling in claudicants and its relationship to physical ability, balance, and quality of life. Vasc Endovascular Surg. 48:297–304. DOI: 10.1177/1538574413519711. PMID: 24444769.

22. Lurie J, Tomkins-Lane C. 2016; Management of lumbar spinal stenosis. BMJ. 352:h6234. DOI: 10.1136/bmj.h6234. PMID: 26727925. PMCID: PMC6887476.

23. Spannbauer A, Chwała M, Ridan T, Berwecki A, Mika P, Kulik A, et al. 2019; Intermittent claudication in physiotherapists' practice. Biomed Res Int. 2019:2470801. DOI: 10.1155/2019/2470801. PMID: 31641667. PMCID: PMC6766680.

24. Mühlhauser Y, Vogt L, Niederer D. 2020; How and how fast does pain lead to disability? A multilevel mediation analysis on structural, temporal and biopsychosocial pathways in patients with chronic nonspecific low back pain. Musculoskelet Sci Pract. 49:102199. DOI: 10.1016/j.msksp.2020.102199. PMID: 32861361.

25. Lee DC, Heo DH, Cho KS. 2019; Concomitant occlusive vascular lesions of legs in patients with degenerative lumbar diseases: do these lesions influence treatment? J Neurol Surg A Cent Eur Neurosurg. 80:8–14. DOI: 10.1055/s-0038-1669474. PMID: 30223290.

26. Thornes E, Robinson HS, Vøllestad NK. 2018; Dynamic balance in patients with degenerative lumbar spinal stenosis; a cross-sectional study. BMC Musculoskelet Disord. 19:192. DOI: 10.1186/s12891-018-2111-x. PMID: 29902972. PMCID: PMC6003037.

27. Lin SI, Lin RM. 2005; Disability and walking capacity in patients with lumbar spinal stenosis: association with sensorimotor function, balance, and functional performance. J Orthop Sports Phys Ther. 35:220–6. DOI: 10.2519/jospt.2005.35.4.220. PMID: 15901123.

28. Kim HJ, Chun HJ, Han CD, Moon SH, Kang KT, Kim HS, et al. 2011; The risk assessment of a fall in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 36:E588–92. DOI: 10.1097/BRS.0b013e3181f92d8e. PMID: 21242866.

29. Fairbank JC, Pynsent PB. 2000; The Oswestry disability index. Spine (Phila Pa 1976). 25:2940–52. DOI: 10.1097/00007632-200011150-00017. PMID: 11074683.

30. Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. 2005; Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 34:614–9. DOI: 10.1093/ageing/afi196. PMID: 16267188.

31. Ammendolia C, Côté P, Southerst D, Schneider M, Budgell B, Bombardier C, et al. 2018; Comprehensive nonsurgical treatment versus self-directed care to improve walking ability in lumbar spinal stenosis: a randomized trial. Arch Phys Med Rehabil. 99:2408–19.e2. DOI: 10.1016/j.apmr.2018.05.014. PMID: 29935152.

32. Ratner B. 2009; The correlation coefficient: its values range between +1/−1, or do they? J Target Meas Anal Mark. 17:139–42. https://doi.org/10.1057/jt.2009.5. DOI: 10.1057/jt.2009.5.

33. Elnady BM, Saeed A. 2017; Peripheral vascular disease: the beneficial effect of exercise in peripheral vascular diseases based on clinical trials. Adv Exp Med Biol. 1000:173–83. DOI: 10.1007/978-981-10-4304-8_11. PMID: 29098622.

34. Wood DW, Haig AJ, Yamakawa KS. 2012; Fear of movement/(re)injury and activity avoidance in persons with neurogenic versus vascular claudication. Spine J. 12:292–300. DOI: 10.1016/j.spinee.2012.02.015. PMID: 22480530. PMCID: PMC3367062.

35. Fujita N, Sakurai A, Miyamoto A, Michikawa T, Otaka Y, Suzuki S, et al. 2019; Stride length of elderly patients with lumbar spinal stenosis: multi-center study using the Two-Step test. J Orthop Sci. 24:787–92. DOI: 10.1016/j.jos.2019.01.006. PMID: 30737067.

36. Broscheid KC, Behrendt T, Hamacher D, Böker S, Gagelmann T, Schmidt C, et al. 2020; Effect of a multimodal movement intervention in patients with neurogenic claudication based on lumbar spinal stenosis and/or degenerative spondylolisthesis-a pilot study. Front Med (Lausanne). 7:540070. DOI: 10.3389/fmed.2020.540070. PMID: 33364242. PMCID: PMC7753178.

37. Curcio CL, Gomez F, Reyes-Ortiz CA. 2009; Activity restriction related to fear of falling among older people in the Colombian Andes mountains: are functional or psychosocial risk factors more important? J Aging Health. 21:460–79. DOI: 10.1177/0898264308329024. PMID: 19318606.

38. Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. 2008; Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 37:19–24. DOI: 10.1093/ageing/afm169. PMID: 18194967.

39. Kori SH, Miller RP, Todd DD. 1990; Kinesiophobia: a new view of chronic pain behaviour. Pain Manag. 3:35–43.

40. Sharath SE, Kougias P, Barshes NR. 2017; The influence of pain-related beliefs on physical activity and health attitudes in patients with claudication: a pilot study. Vasc Med. 22:378–84. DOI: 10.1177/1358863X17709944. PMID: 28545320.

41. Harwood AE, King S, Totty J, Smith GE, Vanicek N, Chetter IC. 2017; A systematic review of muscle morphology and function in intermittent claudication. J Vasc Surg. 66:1241–57. DOI: 10.1016/j.jvs.2017.05.106. PMID: 28822657.

42. Lee BH, Moon SH, Suk KS, Kim HS, Yang JH, Lee HM. 2020; Lumbar spinal stenosis: pathophysiology and treatment principle: a narrative review. Asian Spine J. 14:682–93. DOI: 10.31616/asj.2020.0472. PMID: 33108834. PMCID: PMC7595829.