Spinal Stenosis: An Emerging Complication of Ageing in People With Haemophilia

Abstract

Introduction: Advances in haemophilia care have brought the challenges of ageing for people with haemophilia (PWH) to the forefront. Age-related spinal degeneration may result in spinal stenosis; however, the rates in PWH are unknown. We sought to systematically review Irish PWH to address this gap in the current literature. Methods: Clinical and radiological notes of all patients ≥40 years old (yo) registered with severe or moderate haemophilia A or B were reviewed, recording Haemophilia Joint Health Scores (HJHS), radiological imaging and orthopaedic/pain interventions. Results: Of 100 males included with moderate or severe haemophilia, 13% had radiologically confirmed symptomatic spinal stenosis (reported rates 4% in the general population aged >60 yo). Persons with stenosis were older (median age 69yo vs. 55 yo, p = 0.004) with similar rates observed between those with moderate and severe haemophilia (4/35, 11.4% vs. 9/65, 13.8%). HJHS did not differ between those with and without stenosis (median 30 vs. 35, p = 0.6). On regression analysis, only age >60 yo was associated with an increased likelihood of spinal stenosis; severity of haemophilia (moderate vs. severe) was not significantly associated. Conclusions: These data identify symptomatic spinal stenosis as a novel complication of ageing for PWH. Spinal stenosis rates were higher than expected for age in comparison to reported rates in the general population. Current joint assessments fail to capture spinal pathology, highlighting limitations of HJHS in older PWH. Increased awareness amongst PWH and health care providers of spinal stenosis is directly required; however, optimal management strategies for PWH with established stenosis are yet to be defined.