Background Degenerative foraminal stenosis (DFS) is one the three anatomically locations of degenerative lumbar spinal stenosis (1) and more frequently involves the L5 nerve root (L5 – S1 foramen is the one with the smaller foramen / root area ratio) (2). The treatment options are adapted to clinical and functional status, generated by the severity of pressure on the nerve root complex by the degenerative changes (1, 3).
Objectives The purpose of our randomized controlled study was to compare outcomes between the conservative therapies (activity modifications, medications and physical treatments) and the pharmacotherapy in patients with moderate symptomatic DFS (L5-S1 foramen).
Methods 66 patients with L5 – S1 DFS were randomly assigned to a conservative treatment group – CG (n=36; 23 males, 13 females; mean age [±SD] = 54 ± 8 years) or a pharmacotherapy group – PG (n=28, 15 males, 13 females; mean age [±SD] = 56 ± 7 years). All patients were completely assessed (patient’s description of their symptoms - Konno self-administered diagnostic tool, physical and radiological examinations and functional assessment - The Roland-Morris Disability Questionnaire). Subjects in the CG received activity modifications, medications (similar to PG) and physical therapy (supervised exercise - twice daily stretching and adapted strengthening for lumbar spine, over a 6-week period; in addition we recommended lumbar bracing and performed ultrasounds, TENS and hot packs for 2 weeks). Measured outcomes were the generic QoL scale SF-MOS (Short Form Medical Outcomes Study) and the Roland-Morris Disability Questionnaire (RMDQ) score. Differences parameter values between groups were tested by ANOVA test.
Results Both groups showed clinically and statistically significant improvements in SF-MOS and RMDQ scores at 6 weeks (SF-MOS scores had improved by 43% in the CG and by 21% in the PG; RMDQ scores had improved over 25% in both groups). At 3 months, patients in the CG clinic were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the PG.
Conclusions Although both groups improved by 6 weeks, subjects in the CG achieved about twice as much improvement in SF-MOS scores than subjects in PG. The results indicate that a conservative treatment in moderate symptomatic DFS patients had not only effect on pain and function lumbar status but also a long term effect on perceived recovery. More randomly studies investigating conservative an surgical treatments in all degenerative spinal stenosis are required.
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Disclosure of Interest None Declared
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