Burden of Disease

Although there is some literature on the burden of disease of low back pain in general, we could find only one study of the societal burden of disease specifically for spinal stenosis.  The 1995 population study of two regions in Sweden  (Johnsson, 1995) reported that with a spinal stenosis incidence of about 50 per 100,000, between 42 percent and 58 percent of these patients had claudication (leg pain or weakness upon standing or walking).  From these data, the incidence was calculated as about 25 per 100,000 inhabitants for spinal-stenosis-associated claudication.  More severe stenosis can result in cauda equina syndrome, which is characterized by the loss of sexual function and urinary and/or fecal incontinence.  This same study reported that cauda equina syndrome had an incidence of less than 1 per 100,000.

Review articles (Alvarez and Hardy Jr, 1998; Spivak, 1998; Tatarek and Nancy Elizabeth, 2000) and textbooks  (Gunzburg and Szpalski, 1999; Kirkaldy-Willis and Bernard, 1999) provide anecdotal evidence that individual patients with symptomatic spinal stenosis typically have chronic low back pain and pain and weakness in the legs that limits standing and walking to brief durations and short distances.  This places limitations on the ability to carry out self-supporting daily activities as well as work, social, and recreational activities.  This lack of activity may lead to obesity and general physical deterioration that may eventually result in the onset of cardiovascular and other serious health problems. These activity restrictions may also lead to depression and other psychological problems.  More severe stenosis can result in cauda equina syndrome.  If untreated, severe spinal stenosis is commonly believed to have the potential to result in severe symptoms that may become permanent and unresponsive to medical or surgical treatment (Dawson and Bernbeck, 1998; Hirsch, 1966; Johnsson, Uden, and Rosen, 1991; Johnsson, Uden, and Rosen, 1992; Kirkaldy-Willis and Bernard, 1999; Nagler and Bodack, 1993; Onel, Sari, and Donmez, 1993; Porchet, Vader, Larequi-Lauber et al., 1999; Postacchini, 1988; Shakil, Vaccaro, Albert et al., 1999; Shapiro S, 2000; Shapiro, Cooper, and Miller, 1993; Wiltse, 1977; Wisneski and Farmer, 1994).  However, we could find no data supporting this belief except for acute onset of symptoms with herniated disks (Shapiro S, 2000; Shapiro, Cooper, and Miller, 1993) or postoperative complications (McLaren and Bailey, 1986).