Louis-Sidney Fabienne, Duby Jean-Florent, Signate Aïssatou, Arfi Serge, De Bandt Michel, Suzon Benoit, Cabre Philippe
Service de Rhumatologie, CHU de Fort de France, 97200 Fort de France, France.
Service de Neurologie, CHU de Fort de France, 97200 Fort de France, France.
Biomedicines. 2022 Dec 6;10(12):3144. doi: 10.3390/biomedicines10123144.
(1) Background: Limited data are available on lumbar spine stenosis management in sub-Saharan African populations and Afro-descendant patients are underrepresented in European and US clinical trials. We aimed to compare the clinical response between decompressive surgery and conservative treatments in a population of self-reported Afro-Caribbean patients with lumbar spine stenosis over a 2-year follow-up period. (2) Methods: Prospective cohort of 137 self-reported Afro Caribbeans with lumbar spine stenosis based on clinical and radiological criteria. Patients were assigned to decompression surgery or to conservative treatments according to their outcome after a first course of steroid epidural injection and their preferences. The primary outcome was evolution of the Oswestry disability index at 3 months (3 M), 12 M, 18 M and 24 M follow-up. (3) Results: 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: −17.36 vs. 1.03 p < 10−4; −16.38 vs. −1.53 p = 0.0059 and −19.00 vs. −4.52 p = 0.021, respectively. No difference was reported at 24 M. (4) Conclusions: In this first comparative study between surgery and conservative treatments in an exclusively afro-descendant lumbar spine stenosis cohort, we report long term superiority of decompression surgery versus conservative treatments over an 18-month period.
(1) 背景：关于撒哈拉以南非洲人群腰椎管狭窄症治疗的数据有限，且非洲裔患者在欧美临床试验中的代表性不足。我们旨在比较自我报告为非裔加勒比人的腰椎管狭窄症患者在两年随访期内减压手术与保守治疗的临床反应。(2) 方法：根据临床和影像学标准，对137名自我报告为非裔加勒比人的腰椎管狭窄症患者进行前瞻性队列研究。根据首次硬膜外注射类固醇后的结果及其偏好，将患者分配至减压手术组或保守治疗组。主要结局指标为随访3个月（3M）、12个月、18个月和24个月时Oswestry功能障碍指数的变化。(3) 结果：在3个月、12个月和18个月时，“减压手术”组的ODI下降幅度明显大于“保守治疗”组：分别为−17.36对1.03，p < 10−4；−16.38对−1.53，p = 0.0059；−19.00对−4.52，p = 0.021。24个月时未报告差异。(4) 结论：在这项针对纯非洲裔腰椎管狭窄症队列的手术与保守治疗的首次比较研究中，我们报告了减压手术在18个月期间相对于保守治疗的长期优势。
