BACKGROUND: To investigate whether calcitonin can improve walking distance (WD) and visual analog pain scale (VAS) in patients who suffer lumbar spinal stenosis (LSS).
METHODS: We performed a search on CENTRAL, PubMed, Embase and Cochrane databases up to July 2014; we finally found 19 original articles, of which only 6 were in full compliance with the RCT criteria. These full articles were carefully reviewed independent and in blinded way by two previously capacitated reviewers for the objective to extract data and score a quality of these articles by the criteria of Cochrane Handbook (5.1.0).
RESULTS: We accepted 6 studies with 232 participants. There is no evidence show calcitonin is better than placebo or paracetamol regardless of mode of administration.
CONCLUSIONS: This meta-analysis suggest that calcitonin provide no significant improvement in pain symptoms or walking distance in LSS patients.
BACKGROUND: Lumbar spinal stenosis with neurogenic claudication is one of the most commonly diagnosed and treated pathological spinal conditions. It frequently afflicts the elderly population.
OBJECTIVES: To systematically review the evidence for the effectiveness of nonoperative treatment of lumbar spinal stenosis with neurogenic claudication.
SEARCH METHODS: CENTRAL, MEDLINE, CINAHL, and Index to Chiropractic Literature (ICL) databases were searched up to June 2012.
SELECTION CRITERIA: Randomized controlled trials published in English, in which at least one arm provided data on nonoperative treatments
DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. Risk of bias in each study was independently assessed by two review authors using the 12 criteria recommended by the Cochrane Back Review Group (Furlan 2009). Dichotomous outcomes were expressed as relative risk, continuous outcomes as mean difference or standardized mean difference; uncertainty was expressed with 95% confidence intervals. If possible a meta-analysis was performed, otherwise results were described qualitatively. GRADE was used to assess the quality of the evidence.
MAIN RESULTS: From the 8635 citations screened, 56 full-text articles were assessed and 21 trials (1851 participants) were included. There was very low-quality evidence from six trials that calcitonin is no better than placebo or paracetamol, regardless of mode of administration or outcome assessed. From single small trials, there was low-quality evidence for prostaglandins, and very low-quality evidence for gabapentin or methylcobalamin that they improved walking distance. There was very low-quality evidence from a single trial that epidural steroid injections improved pain, function, and quality of life, up to two weeks, compared with home exercise or inpatient physical therapy. There was low-quality evidence from a single trial that exercise is of short-term benefit for leg pain and function compared with no treatment. There was low and very low-quality evidence from six trials that multimodal nonoperative treatment is less effective than indirect or direct surgical decompression with or without fusion. A meta-analysis of two trials comparing direct decompression with or without fusion to multimodal nonoperative care found no significant difference in function at six months (mean difference (MD) -3.66, 95% CI -10.12 to 2.80) and one year (MD -6.18, 95% CI -15.03 to 2.66), but at 24 months a significant difference was found favouring decompression (MD -4.43, 95% CI -7.91 to -0.96).
AUTHORS' CONCLUSIONS: Moderate and high-quality evidence for nonoperative treatment is lacking and thus prohibits recommendations for guiding clinical practice. Given the expected exponential rise in the prevalence of lumbar spinal stenosis with neurogenic claudication, large high-quality trials are urgently needed.
BACKGROUND: Lumbar spinal stenosis (LSS) is prevalent in those over the age of 65 years and the leading cause of spinal surgery in this population. Recent systematic reviews have examined the effectiveness of conservative management for LSS, but not relative to surgical interventions. The aim of this review was to systematically examine the effectiveness of land based exercise compared with decompressive surgery in the management of patients with LSS.
METHODS: A systematic review of randomised controlled trials and clinical trials was undertaken. The databases MEDLINE, Embase, CINAHL, PEDro and Cochrane Library Register of Controlled Trials were searched from January 2000 to June 2011. Only studies that included subjects with lumbar spinal canal stenosis were considered in this review. Studies also had to use a patient reported functional outcome measure for a land based exercise intervention or lumbar decompressive surgery.
RESULTS: Only one study compared the effectiveness of exercise and decompressive surgery for LSS. Surgery demonstrated statistically significant improvements in patient reported functional outcome scores at 6, 12 and 24-months post-intervention (p < 0.01). To facilitate further analysis, the results from 12 exercise and 10 surgical intervention arms were compared using percentage change in patient reported functional outcome measure scores. Exercise interventions showed initial improvements, ranging from 16 to 29% above baseline. All decompressive surgical interventions demonstrated greater and sustained improvements over 2-years (range 38-67% improvement) with moderate to large effect sizes. The most commonly reported complications associated with surgery were dural tears, while details of adverse effects were lacking in exercise interventions.
CONCLUSIONS: This systematic review of the recent literature demonstrates that decompressive surgery is more effective than land based exercise in the management of LSS. However, given the condition's slowly progressive nature and the potential for known surgical complications, it is recommended that a trial of conservative management with land based exercise be considered prior to consideration of surgical intervention.
To investigate whether calcitonin can improve walking distance (WD) and visual analog pain scale (VAS) in patients who suffer lumbar spinal stenosis (LSS).
METHODS:
We performed a search on CENTRAL, PubMed, Embase and Cochrane databases up to July 2014; we finally found 19 original articles, of which only 6 were in full compliance with the RCT criteria. These full articles were carefully reviewed independent and in blinded way by two previously capacitated reviewers for the objective to extract data and score a quality of these articles by the criteria of Cochrane Handbook (5.1.0).
RESULTS:
We accepted 6 studies with 232 participants. There is no evidence show calcitonin is better than placebo or paracetamol regardless of mode of administration.
CONCLUSIONS:
This meta-analysis suggest that calcitonin provide no significant improvement in pain symptoms or walking distance in LSS patients.
