Shahidi Bahar, Zavareh Armin, Richards Connor, Taitano Lissa, Raiszadeh Kamshad
University of California, San Diego, Department of Orthopaedic Surgery; 9500 Gilman Dr. MC0863, La Jolla CA, 92093 USA.
Livara Health, 7525 Metropolitan Dr. Unit 306, San Diego CA ,92018 USA.
medRxiv. 2024 Sep 23:2024.09.20.24314088. doi: 10.1101/2024.09.20.24314088.
Spine pain is a prevalent and costly condition affecting up to 85% of individuals throughout their lifetime, and spinal stenosis is one of the most debilitating sources of spine pain. Although conservative management is the first line of treatment for spinal stenosis, severe cases often are directly referred to surgical intervention due to the belief that conservative strategies delay necessary treatment. However, there are no studies supporting the premise that individuals with more severe stenosis respond poorly to conservative management. The purpose of this study was to compare improvements in pain, disability, strength, medication usage, and patient goals in response to an exercise-based physical therapy program across 1,806 individuals with mild, moderate, or severe lumbar spine stenosis. Participants demonstrated significant improvements in all variables of interest (p<0.001), and 11.5% of participants reported cessation of narcotic use with treatment. There were no significant differences in treatment response across mild, moderate, or severe stenosis groups for any outcome (p>0.546). Exercise-based rehabilitation is as beneficial in the short term for individuals presenting for nonoperative care with severe stenosis compared to their milder counterparts. Future research is needed to evaluate long term durability and cost effectiveness of rehabilitation in this patient population.
脊柱疼痛是一种普遍且代价高昂的病症，一生中高达85%的人都会受到影响，而椎管狭窄是导致脊柱疼痛最使人衰弱的原因之一。尽管保守治疗是椎管狭窄的一线治疗方法，但严重病例往往直接接受手术干预，因为人们认为保守策略会延迟必要的治疗。然而，没有研究支持严重狭窄患者对保守治疗反应不佳这一前提。本研究的目的是比较1806例轻度、中度或重度腰椎管狭窄患者在接受基于运动的物理治疗方案后，在疼痛、功能障碍、力量、药物使用和患者目标方面的改善情况。参与者在所有感兴趣的变量上都有显著改善（p<0.001），11.5%的参与者报告在治疗后停止使用麻醉药品。对于任何结果，轻度、中度或重度狭窄组的治疗反应均无显著差异（p>0.546）。与轻度狭窄患者相比，基于运动的康复治疗对因严重狭窄而接受非手术治疗的患者在短期内同样有益。需要进一步的研究来评估该患者群体康复治疗的长期效果和成本效益。
