Spinal stenosis prevalence and association with symptoms: the Framingham Study

Background context: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear. Purpose: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP. Study design/setting: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study. Patient sample: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study. Outcome measures: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12 mm for relative LSS and 10 mm for absolute LSS. Methods: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index. Results: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53). Conclusions: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP.