Background: The symptom severity of back pain/leg pain is not correlated with the severity
of degenerative changes and canal stenosis in lumbar stenosis. Considering the individual
pain sensitivity might play an important role in pain perception, this discordance between the
radiologic findings and clinical symptoms in degenerative lumbar stenosis might originate from
the individual difference of pain sensitivity for back pain and/or leg pain.
Objective: To determine the relationship among the clinical symptoms, radiologic findings,
and the individual pain sensitivity in the patients with degenerative lumbar spinal stenosis.
Study Design: Retrospective analysis of prospectively collected data.
Setting: A spine center in the department of orthopedic surgery.
Methods: In 94 patients who had chronic back pain and/or leg pain caused by degenerative
lumbar spinal stenosis, a medical history, a physical examination, and completion of a series
of questionnaires, including pain sensitivity questionnaire (PSQ) [total PSQ and PSQ-minor],
Oswestry Disability Index (ODI), Visual Analog Pain Scale (VAS) for back pain, and Short Form36 (SF-36) were recorded on the first visit. Radiologic analysis was performed using the MRI
findings. The grading of canal stenosis was based on the method by Schizas, and the degree of
disc degeneration was graded from T2-weighted images with the Pfirrmann classification. The
correlations among variables were statistically analyzed.
Results: Total PSQ and PSQ-minor were not dependent on the grade of canal stenosis after
gender adjustment. VAS for leg pain and back pain was highly associated with the total PSQ and
the PSQ-minor. Total PSQ and PSQ-minor were also significantly associated with ODI. Among SF36 scales, the PSQ minor had significant correlations with SF-36 such as bodily pain (BP), Roleemotional (RE), and Mental Component Summary (MCS) after control of confounding variables
such as body mass index (BMI), age, and the grade of canal stenosis/disc degeneration. Total
PSQ was significantly associated with the SF-36 RP, BP, and RE. Furthermore, after adjustment
for gender and pain sensitivity, there was no significant association between the grade of canal
stenosis and VAS for back pain/leg pain and ODI, and no correlation was found between the
grade of disc degeneration and VAS for back pain/leg pain and ODI, either.
Limitations: The multiple lesions of canal stenosis and/or disc degeneration and the grade of
facet degeneration were not considered as a variable.
Conclusion: The current study suggests that the pain sensitivity could be a determining factor
for symptom severity in the degenerative spinal disease.
Key words: Pain sensitivity, pain sensitivity questionnaire, lumbar spinal stenosis, visual analog
pain scale, Oswestry disability index, Short Form-36
Results of surgical treatment of degenerative stenosis of the lumbar spine in elderly and old patients
