A Case of Peripheral Arterial Disease Presenting with Groin Pain after Surgery for Lumbar Canal Stenosis

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  • 腰部脊柱管狭窄症の術後に鼠径部痛で発症した末梢動脈閉塞症の1例

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<p>  Both lumbar canal stenosis (LCS) and peripheral arterial disease (PAD) can cause groin pain. Although differentiating the two pathologies is essential, it can be more challenging in patients with groin pain. We report the case of a 71-year-old woman with PAD who presented with left groin pain after surgery for LCS at L4/5. Before the surgery, she had paresis of her left toe and intermittent claudication (IC) caused by pain in the left groin and L5 dermatome. Magnetic resonance imaging (MRI) showed a lateral recess stenosis with slippage at L4/5. As the arterial pulses in the lower extremities were palpable with normal skin color, we diagnosed a neurogenic IC due to LCS despite a low ankle brachial index (ABI) of 0.54 (≤0.9). A decompressive surgery of the L5 nerve root completely relieved preoperative symptoms; however, IC with left groin pain recurred 3 months after the surgery. Physical examination, selective L5 nerve root block and imaging studies of the lumbar, hip joint, and pelvis could not identify the cause. Finally, a cardiologist noticed the poor color tone of her left sole and diagnosed a symptomatic PAD (left common iliac artery occlusion) with an ABI of 0.29. She underwent stent placement with dual antiplatelet therapy, resulting in the prompt disappearance of the vascular IC. A close review of the initial plain radiograph and computed tomography confirmed severe calcifications of the abdominal aorta and iliac arteries. Spine surgeons tend to overlook the possibility of a coexisting PAD in patients with degenerative changes corresponding to LCS, and physical findings can be insufficient to differentiate them. Therefore, PAD should be screened in every IC patient using the ABI. In the case of an ABI less than 0.9, further vascular examinations should be done. </p>

Journal

  • Spinal Surgery

    Spinal Surgery 34 (2), 169-173, 2020

    The Japanese Society of Spinal Surgery

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