Document Detail


An arterial pulse examination is not sufficient for diagnosis of peripheral arterial disease in lumbar spinal canal stenosis: a prospective multicenter study.
MedLine Citation:
PMID:  21217453     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Study Design. Prospective, multicenter study.Objective. To conduct peripheral arterial disease (PAD) screening on Intermittent claudication (IC) patients with lumbar spinal canal stenosis (LSCS) to examine the relationships among combined LSCS and PAD, symptoms, and physical findings.Summary of Background Data. IC occurs due to two underlying diseases, LSCS and PAD, and has an increasing prevalence with the aging of society. Reliable diagnosis of PAD is critical for appropriate conservative management of IC patients with LSCS in an Orthopedic Surgery Outpatient Department (OSOPD).Methods. PAD tests were prospectively conducted in 201 patients with IC and LSCS who initially visited an OSOPD at a hospital affiliated with the Nogoya Spine Group. Occurrence of PAD as a complication was assessed using ABI (ankle brachial pressure index) and TBI (toe brachial pressure index) tests. PAD was diagnosed in patients with ABI ≤ 0.9 or TBI ≤ 0.6, and the relationship of the occurrence of PAD with symptoms and physical findings such as abnormal arterial pulses was investigated.Results. Combined LSCS and PAD was found in 52 patients (26%), with 45 cases (22%) diagnosed based only on the TBI test in patients with a normal ABI. Of the patients with PAD, many suffered from risk factors for PAD, with a significantly higher frequency of PAD in patients with hyperlipidemia (p<0.05). PAD also occurred significantly more frequently in patients with abnormal pulses in the popliteal (p<0.05), posterior tibial (p<0.0001), and dorsal pedis (p<0.0001) arteries; however, the sensitivity of these tests for PAD diagnosis was relatively low, at 34%, 60% and 68%, respectively.Conclusion. The results of the prospective study define the rate of occurrence of combined LSCS and PAD using ABI and TBI tests for the first time, and the findings suggest that screening for PAD should be conducted in LSCS patients. ABI and TBI tests are necessary for PAD screening in outpatients, whereas observation of the arterial pulse in the lower extremities is necessary but not sufficient for PAD diagnosis.
Authors:
Shiro Imagama; Yukihiro Matsuyama; Yoshihito Sakai; Zenya Ito; Norimitsu Wakao; Masao Deguchi; Yudo Hachiya; Yoshimitsu Osawa; Hisatake Yoshihara; Mitsuhiro Kamiya; Tokumi Kanemura; Fumihiko Kato; Yasutsugu Yukawa; Toru Yoshida; Atsushi Harada; Noriaki Kawakami; Kazuhiro Suzuki; Yuji Matsubara; Manabu Goto; Koji Sato; Koji Maruyama; Makoto Yanase; Yoshihiro Ishida; Naoto Kuno; Takao Hasegawa; Naoki Ishiguro; Shiro Imagama; Yukihiro Matsuyama; Yoshihito Sakai; Zenya Ito; Norimitsu Wakao; Naoki Ishiguro; Masao Deguchi; Yudo Hachiya; Yoshimitsu Osawa; Hisatake Yoshihara; Mitsuhiro Kamiya; Tokumi Kanemura; Fumihiko Kato; Yasutsugu Yukawa; Toru Yoshida; Atsushi Harada; Noriaki Kawakami; Kazuhiro Suzuki; Yuji Matsubara; Manabu Goto; Koji Sato; Koji Maruyama; Makoto Yanase; Yoshihiro Ishida; Naoto Kuno; Takao Hasegawa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-6
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65,Turumai, Showa-ku, Nagoya-shi, 466-8550, Japan, Phone: +81-51-741-2111, Fax: +81-52-744-2260, E-mail: Imagama@med.nagoya-u.ac.jp 2Department of Orthopaedic Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano, 380-8582,Japan 3Hachiya Orthopaedic Hospital, 2-4, Suemoridori, Chikusa-ku, Nagoya, 464-0821, Japan 4Department of Orthopaedic Surgery, Nagoya First Red Cross Hospital, 3-35, Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan 5Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, 50, Hachikennishi, Aotake-cho, Toyohashi-shi,441-8570, Japan 6Department of Orthopaedic Surgery, Aichi Medical University, 21,Karimata, Iwasaku, Nagakute-cho, Aichi-gun,480-1195, Japan 7Department of Orthopaedic Surgery, Konan Kosei Hospital, 46, Nobaku, Nobaku-cho, Konan-shi, 483-8202, Japan 8Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6, Koumei,Minato-ku, Nagoya-shi, 455-8530, Japan 9Yoshida Orthopaedic Surgery 10National Center for Geriatrics and Gerontology 11Department of Orthopaedic Surgery, Meijo Hospital 12Department of Orthopaedic Surgery, Anjo Kosei Hospital 13Department of Orthopaedic Surgery, Kariya-Toyota General Hospital 14Goto Orthopaedic Surgery 15Department of Orthopaedic Surgery, Nagoya 2nd red cross Hospital 16Department of Orthopaedic Surgery, Nakatsugawa municipal Hospital 17Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital 18Department of Orthopaedic Surgery, Handa Municipal Hospital 19Department of Orthopaedic Surgery, Tokoname Orthopaedic Surgery 20Department of Orthopaedic Surgery, Tokai-Kinen Hospital.
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