Risk Factors for Atherothrombotic Disease and Lumbar Spinal Stenosis: Results from the PREFACE Study

Background and aim: Atherothrombotic disease of feeding arteries of lumbar spine could be an underlying mechanism for Lumbar Spinal Stenosis (LSS). We aimed at evaluating the association of a large panel of risk factors for atherothrombotic disease, alone or in combination, with LSS in multivariable models. Methods: Case-control study: 213 consecutive patients with LSS, eligible for surgery at the Neurosurgery Department of IRCCS Neuromed, were enrolled in the PREFACE study; 426 controls, matched 1: 2 for sex, age (± 6 months) and physical activity, without a history or clinical evidence of LSS were selected from the general population. Odds Ratios (ORs) and their 95% Confidence Intervals (CIs) were calculated using conditional-tomatch (for age and sex) logistic regression. Results: Manual occupation, current smoking, high waist-to-hip ratio, history of hypertension, diabetes and dyslipidemia were independently associated with higher odds of developing LSS in multivariable analysis (p<0.001). Only 1.5% of patients with LSS showed absence of risk factors, in comparison with 6.7% in controls (p<0.001). The risk of LSS linearly increased with the increased presence of risk factors. The presence of 3 or more risk factors compared with none was associated with 13 times higher risk of LSS (OR: 13.04; 95% CI: 2.87-59.27) Conclusion: Risk factors for cardiovascular disease and in particular metabolic risk factors are associated with increased risk of LSS. Management of LSS should take into consideration the control of modifiable atherothrombotic risk factors.