Biomedicines, Vol. 10, Pages 3144: Lumbar Spinal Stenosis Treatment: Is Surgery Better than Non-Surgical Treatments in Afro-Descendant Populations?

3.1. Population

On 137 patients eligible for second phase of study, 132 were included.

Surgical decompression, second course of epidural steroid injections and clinical follow-up were proposed to 27, 69 and 36 patients, respectively.

After patients’ wishes were considered, 25, 36, and 71 patients were offered surgery, epidural steroids injections and clinical follow-up, respectively. Patients from the clinical follow-up and epidural steroids injections were pooled into a single “conservative treatments” arm.

Mean age of population was 62.5 (±13.2) years. A total of 55 (41.67%) patients were male. Concerning occupational status, 79 (14.4%) patients were retired, 14 (10.6%) unemployed, 18 (13.6%) on medical leave and 21 (15.9%) were full or part-time workers.

Body mass index (BMI) was above 25 kg/m2 in 70.63% of cases. Sixty-seven (50.76%) and twenty-nine (21.97%) patients had high blood pressure (HBP) and diabetes mellitus (DM) respectively. Multilevel lumbar stenosis was reported in 48 (36.4%) patients of the cohort. Three cohort patients had lumbar spine stenosis with an associated lumbar spondylolisthesis.

A comparative analysis of “conservative treatments” arm and “surgery” arm is presented in Table 1. At baseline, both arms were comparable for age, male/female ratio, BMI, HBP, DM and duration of symptoms (p = 0.86, p = 0.38, p = 0.72, p = 1, p = 0.12, p = 0.41 respectively). The Owestry disability index and VAS-LP were significantly higher and foraminal stenosis significantly more frequent in the “decompression surgery” arm (p = 0.02, p = 0.0006, p = 10−3, respectively).

No significant difference between both arms was reported for VAS-BP (p = 0.11).

3.2. Changes in ODI (ΔODI), VAS-LP (ΔVAS-LP) and VAS-BP (ΔVAS-BP)Comparative ΔODI, ΔVAS-LP and ΔVAS-BP between “conservative treatments” and “surgery” arms are presented in Table 2.

Decrease of ODI was significantly more important in the “decompression surgery” arm compared to “conservative treatment” arm at 3 M, 12 M and 18 M: p < 10−4, p = 0.0059 and p = 0.021, respectively.

Decrease in VAS-LP was significantly higher in the “surgery” arm compared to “conservative treatment” arm at 3 M and 18 M: p < 10−4 and p = 0.0012, respectively. A tendency to higher VAS-LP decreases in the “surgery” arm at 12 M (p = 0.09).

Self-reported improvement was correlated to decrease of ODI and VAS-LP, with a significant higher proportion of patients reporting it in the “surgery” arm at 3 M and 18 M (p = 0.0036 and p = 0.048) and a tendency at 12 M (p = 0.06).

No difference in VAS-BP evolution was observed at any time of follow-up between both arms.

Multivariate analyses of ODI and VAS-LP changes are presented in Table 3.

Adjusted on baseline ODI, significant higher decrease was observed for ODI at 3 M, 12 M and 18 M in the “surgery” arm (p = 0.048 at 3 M, 12 M and 18 M).

Adjusted on baseline VAS-LP, significant higher decrease was observed for VAS-LP at 3 M and 18 M (p = 10−4 and p = 0.0068, respectively), and a tendency for higher decrease at 12 M (p = 0.07). No significant difference was observed for ΔODI or ΔVAS-LP at 24 M.

In the surgery arm, ODI at 3 M, 12 M, 18 M and 24 M was 30.52 (±18.09), 32.33 (±18.22), 28.56 (±16.76) and 37 (±19.06), respectively.

In that same arm, VAS-LP at 3 M, 12 M, 18 M and 24 M was 26.76 (±23.63), 35.95 (±29.53), 30.05 (±17.82) and 40.88 (±32.27), respectively; and VAS-BP was 34.72 (±26.89), 31.38 (±20.39), 36.18 (±24.15) and 41.24(±25.09), respectively.

No difference was reported between surgery and conservative treatment arms for ODI, VAS-LP and VAS-BP, except for VAS-LP at 3 M, which was significantly higher in the conservative treatments arm compared to the surgery arm (p = 0.01).

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