Aeolus myth: chronic obstructive lung disease and nocturnal lumbosacral pain in association with lumbar spinal stenosis and pulmonary hypertension

OBJECTIVE: To describe an association between the syndromes of lumbar spinal stenosis and chronic obstructive pulmonary disease (COPD) in patients presenting with symptoms of nocturnal lumbosacral radiculopathy. DESIGN: Retrospective review of 46 sequential inpatients referred with complaints of lumbosacral radicular pain associated with lumbar spinal stenosis. Half (23) were experiencing sleep disruptive nocturnal pain. Each had been hospitalized with a primary diagnosis of COPD. They were subsequently compared with another group of inpatients (23) who were also experiencing lumbar pain not necessarily increased at night. Each was also identified as having lumbar spinal stenosis without an antecedent history of COPD. In each case, lumbar spinal imaging studies (computed tomography or magnetic resonance imaging) were obtained. Pulmonary function tests were performed in those with COPD, and two-dimensional echocardiograms were obtained in all 46 patients. RESULTS: The ratio of women to men, their ages, surgical interventions, severity of lumbar spinal stenosis, and left ventricular function as compared one group with another was not significantly different. However, pulmonary artery pressures were notably elevated (i.e., pulmonary hypertension) in those with COPD and nocturnal lumbosacral radiculopathy. CONCLUSION: This study suggests that in patients with COPD and lumbar spinal stenosis, pulmonary hypertension may be the dynamic link exacerbating nocturnal lumbosacral pain.