Spine Journal - 2026-09-01 - Journal Article
Familial risks of hospital treated spinal stenosis in first-, second-, and third-degree relatives: A nationwide family study.
Anker-Hansen C, Pirouzifard M, Sundquist J, Sundquist K, Zöller B
Topics
Key Takeaway
First-degree relatives of spinal stenosis patients carry a familial hazard ratio of 2.47 for developing hospital-treated spinal stenosis, with twins showing an afHR of 5.12, confirming significant hereditary contribution.
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Summary
This nationwide Swedish registry study quantified familial risk of hospital-treated spinal stenosis across first-, second-, and third-degree relatives by linking the Multigeneration Register to the National Patient Register. Adjusted familial hazard ratios were 5.12 for twins, 2.47 for full siblings, 1.49 for half-siblings, and 1.10 (non-significant) for cousins; cervical SS carried a higher sibling afHR (5.38) than lumbar SS (3.01). Amyloidosis was present in 0.27% of SS patients and independently conferred an adjusted HR of 2.03 for SS.
Key Limitation
The registry captures only hospital-treated (ICD-coded) spinal stenosis, excluding conservatively managed patients and introducing ascertainment bias that conflates disease heritability with heritability of disease severity or healthcare-seeking behavior.
Original Abstract
BACKGROUND CONTEXT
Spinal stenosis (SS) has a multifactorial background.
PURPOSE
This nationwide study aimed to determine the familial risks of hospital treated SS in first-, second-, and third-degree relatives in Sweden.
STUDY DESIGN
The Swedish Multigeneration register was linked to the National Patient Register to investigate the heredity of hospital treated SS between 1997 and 2018.
PATIENT SAMPLE
Offspring born to Swedish-born parents were included.
OUTCOME MEASURES
Familial hazard ratios (HRs) for SS were calculated for relatives of individuals who had a diagnosis of SS compared with relatives of individuals unaffected by SS as the reference group. The adjusted familial hazard ratios (afHRs) with 95% confidence interval (CI) were determined for SS among pairs of twins, full-siblings, half-siblings, and cousins.
METHODS
Adjustments were made for birth year, sex, education, occupation, and comorbidities including amyloidosis.
RESULTS
A total of 6,548,565 individuals (48.77% women) were included with a mean age of 41 years (range 0-87 years) at the end of follow-up. 36,958 (0.56%) individuals were affected with hospital treated SS. The afHR for SS were for twins 5.12 (95%CI 3.33-7.89), siblings 2.47 (95%CI 2.35-2.60), half-siblings 1.49 (95%CI 1.28-1.73), and cousins 1.10 (95%CI 0.85-1.43). Among full siblings, afHRs were 5.38 (95%CI 2.02-14.33) for cervical SS and 3.01 (95%CI 2.69-3.67) for lumbar SS. A total of 0.27% SS patients had amyloidosis. Patients with amyloidosis had an adjusted HR of 2.03 (95%CI 1.67 - 2.48) for SS.
CONCLUSIONS
Heredity is associated with higher risk of hospital treated SS in the Swedish population.