Abstract
Background and Study Aims Vascular narrowing or obstruction reduces blood flow to the lower limbs during exercise
or at rest. Symptoms may range from intermittent claudication to pain at rest. Narrowing
of these arteries may produce pain in the buttocks, thighs, or legs. These symptoms
may resemble those of lumbar radicular pain. Spine surgeons may overlook obstructive
vascular lesions of the lower limbs in patients with lumbar degenerative diseases
such as spinal stenosis and spondylolisthesis. We investigated the clinical and radiologic
risk factors of concomitant vascular pathologic lesions in patients with degenerative
lumbar diseases.
Materials and Methods If patients presented with a weak or absent dorsalis pedis artery pulse, edema of
both legs, and a past history related to vascular lesions of the lower limbs, we evaluated
the veins and arteries of the lower extremities using Doppler sonography. If abnormal
vascular findings were detected, computed tomography angiography (CTA) of the lower
extremities was performed. Radiologic and clinical risk factors of concomitant occlusive
arterial lesions of the lower limb were analyzed by logistic regression analysis.
Results In 2013, 335 patients suspected of having vascular lesions underwent Doppler sonography.
Among them, CTA of the lower extremities was performed in 58 patients. The mean age
was 69.4 years (35 men and 23 women). Severe narrowing or total occlusion of the leg
arteries was detected in 23 patients. Partial obstructive arterial disease of the
legs was detected in 14 patients. Occlusion but with good collateral circulation of
the leg was found in three patients. Surgical treatment plans were cancelled or changed
in 28 patients. The risk factors for occlusive arterial lesions of the legs were an
abnormal ankle-brachial pressure index (ABPI), absent dorsalis pedis artery pulse,
and lack of response after a pain-blocking procedure.
Conclusion If patients present with a weak or absent dorsalis pedis artery pulse, abnormal ABPI
ratio, and no response after a pain-blocking procedure, the clinician should consider
the possibility of severe arterial occlusion of the legs. We suggest that the differential
diagnosis of obstructive arterial lesions of the legs from lumbar degenerative diseases
is important to prevent unnecessary invasive surgical treatment of the lumbar spine.
Keywords
claudication - lumbar degenerative disease - vascular occlusion - lower extremity
