Analysis Of Related Factors For Lumbar Spinal Stenosis Combined With Cervical Spinal Stenosis

Objective:To investigate the relevant impact factors of lumbar spinal stenosis combined with cervical spinal stenosis,and to provide an early diagnostic basis for lumbar spinal stenosis accompanied by cervical spinal stenosis.Materials and Methods:A total of 134 patients with lumbar spinal stenosis who were diagnosed and admitted to the Department of Spinal Surgery of Affiliated Hospital of Qingdao University from April 2019 to October 2020 were included.There were 58 male patients and 76 female patients,aged 54 to 76 years old,with an average age of(65±7)years old.After admission,relevant examinations were completed,including cervical,thoracic and lumbar MRI,and the patients were divided into two group which were the no or mild cervical spinal stenosis group and moderate or severe cervical spinal stenosis group according to the cervical spinal stenosis index.Clinical data of the two groups were collected,including gender,age,body mass index,smoking history,symptom duration,history of hypertension,history of diabetes,history of ossification of the cervical posterior longitudinal ligament,severity of intermittent claudication,cervical spinal canal ratio,lumbar spinal canal ratio,type of lumbar spinal stenosis and number of segments of lumbar spinal stenosis(multiple segment/single segments).The above clinical data were compared between the two groups.At the same time,the variables with differences between the two groups were analyzed by univariate Logistic regression with outcomes,and multivariate adjustment.Receivers operating characteristic curve(ROC)was used to evaluate the diagnostic ability of related factors for lumbar spinal stenosis combined with moderate or severe cervical spinal stenosis.Combined with sensitivity and specificity,the maximum point of Youden index was determined as the optimal critical diagnostic value.At the same time,Pearson correlation was used to analyze the correlation between lumbar spinal stenosis combined with cervical spinal stenosis and its influencing factors,as well as the correlation between cervical spinal stenosis and lumbar spinal stenosis.Results:Ninety-eight patients(73.1%,98/134)were enrolled in the group with no or mild cervical spinal stenosis,and 36 patients(26.9%,36/134)were enrolled in the group with moderate or severe cervical spinal stenosis.In the moderate or severe cervical spinal stenosis group,13 patients had atypical neck discomfort,4 patients had positive Hoffmann sign,and the remaining patients had no obvious clinical symptoms related to cervical spinal stenosis.There was no significant difference in symptom duration,body mass index,smoking history,history of hypertension,history of diabetes,history of ossification of the posterior longitudinal ligament of cervical vertebra,severity of intermittent claudication,lumbar spinal canal ratio and type of lumbar spinal stenosis between the two groups(P > 0.05).There were statistically significant differences in terms of gender,age,cervical spinal canal ratio and the number of segments of lumbar spinal stenosis(multiple segment/single segments)(P < 0.05).Furthermore,the gender,age,cervical spinal canal ratio and segments number of lumbar spinal stenosis(multiple segment/single segments)were analyzed by multivariate logistic regression analysis.The results showed that the age(OR=1.087,95%CI=1.012-1.167,P=0.022)and cervical spinal canal ratio(OR=0.873,95%CI=0.786-0.916,P < 0.001)were the independent influencing factors for patients with lumbar spinal stenosis complicated with moderate or severe cervical spinal stenosis.The optimal critical diagnostic value of age was 67.5 years(AUC=0.684;P=0.001),the optimal critical diagnostic value of cervical spinal canal ratio was 76.5%(AUC=0.765;P < 0.001).In addition,Pearson correlation analysis showed a positive correlation between cervical spinal stenosis index and age(r=0.307;P < 0.001).There was a negative correlation between the cervical spinal stenosis index and the cervical spinal canal ratio(r=-0.348;P < 0.001).There was a positive correlation between cervical spinal stenosis index and lumbar spinal stenosis index(r=0.513;P < 0.001).Conclusion:Male or multilevel lumbar spinal stenosis patients have higher risk for moderate or severe cervical spinal stenosis.Age and cervical spinal canal ratio are independent impact factors for lumbar spinal stenosis combined with moderate or severe cervical spinal stenosis.And they can be used as early diagnostic basis for lumbar spinal stenosis accompanied by cervical spinal stenosis.