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European Spine Journal
Published in: European Spine Journal 6/2014

01-06-2014 | Review Article

What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review

Authors: Carlo Ammendolia, Kent Stuber, Christy Tomkins-Lane, Michael Schneider, Y. Raja Rampersaud, Andrea D. Furlan, Carol A. Kennedy

Published in: European Spine Journal | Issue 6/2014

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Abstract

Purpose

To investigate what interventions can improve walking ability in neurogenic claudication with lumbar spinal stenosis.

Methods

We searched CENTRAL, Medline, EMBASE, CINAHL and ICL databases up to June 2012. Only randomized controlled trials published in English and measuring walking ability were included. Data extraction, risk of bias assessment, and quality of the evidence evaluation were performed using methods of the Cochrane Back Review Group.

Results

We accepted 18 studies with 1,220 participants. There is very low quality evidence that calcitonin is no better than placebo or paracetamol regardless of mode of administration. There is low quality evidence that prostaglandins, and very low quality evidence that gabapentin or methylcobalamin, improves walking distance. There is low and very low quality evidence that physical therapy was no better in improving walking ability compared to no treatment, oral diclofenac plus home exercises, or combined manual therapy and exercise. There is very low quality evidence that epidural injections improve walking distance up to 2 weeks compared to placebo. There is low- and very low-quality evidence that various direct decompression surgical techniques show similar significant improvements in walking ability. There is low quality evidence that direct decompression is no better than non-operative treatment in improving walking ability. There is very low quality evidence that indirect decompression improves walking ability compared to non-operative treatment.

Conclusions

Current evidence for surgical and non-surgical treatment to improve walking ability is of low and very low quality and thus prohibits recommendations to guide clinical practice.
Appendix
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Literature
1.
Suri P, Rainville J, Kalichman L, Katz JN (2010) Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis? JAMA 304:2628–2636PubMedCentralPubMedCrossRef
2.
3.
Comer CM, Redmond AC, Bird HA, Conaghan PG (2009) Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists. BMC Musculoskelet Disord 10:121PubMedCentralPubMedCrossRef
4.
Fanuele JC, Birkmeyer NJ, Abdu WA, Tosteson TD, Weinstein JN (2000) The impact of spinal problems on the health status of patients: have we underestimated the effect? Spine (Phila Pa 1976) 25:1509–1514CrossRef
5.
Winter CC, Brandes M, Muller C et al (2010) Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study. BMC Musculoskelet Disord 11:233PubMedCentralPubMedCrossRef
6.
Iversen MD, Katz JN (2001) Examination findings and self-reported walking capacity in patients with lumbar spinal stenosis. Phys Ther 81:1296–1306PubMed
7.
Jonsson B, Annertz M, Sjoberg C, Stromqvist B (1997) A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: clinical features related to radiographic findings. Spine (Phila Pa 1976) 22:2932–2937CrossRef
8.
Jansson KA, Nemeth G, Granath F, Jonsson B, Blomqvist P (2009) Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis. J Bone Joint Surg Br 91:210–216PubMedCrossRef
9.
Furlan AD, Pennick V, Bombardier C, van Tulder TM (2009) 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976) 34:1929–1941CrossRef
10.
Atkins D, Eccles M, Flottorp S et al (2004) Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res 4:38PubMedCentralPubMedCrossRef
11.
Eskola A, Pohjolainen T, Alaranta H, Soini J, Tallroth K, Slatis P (1992) Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up. Calcif Tissue Int 50:400–403PubMedCrossRef
12.
Podichetty VK, Segal AM, Lieber M, Mazanec DJ (2004) Effectiveness of salmon calcitonin nasal spray in the treatment of lumbar canal stenosis: a double-blind, randomized, placebo-controlled, parallel group trial. Spine (Phila Pa 1976) 29:2343–2349CrossRef
13.
Porter RW, Miller CG (1988) Neurogenic claudication and root claudication treated with calcitonin. A double-blind trial. Spine (Phila Pa 1976) 13:1061–1064CrossRef
14.
Porter RW, Hibbert C (1983) Calcitonin treatment for neurogenic claudication. Spine (Phila Pa 1976) 8:585–592CrossRef
15.
Sahin F, Yilmaz F, Kotevoglu N, Kuran B (2009) The efficacy of physical therapy and physical therapy plus calcitonin in the treatment of lumbar spinal stenosis. Yonsei Med J 50:683–688PubMedCentralPubMedCrossRef
16.
Tafazal SI, Ng L, Sell P (2007) Randomised placebo-controlled trial on the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis. Eur Spine J 16:207–212PubMedCentralPubMedCrossRef
17.
Fukusaki M, Kobayashi I, Hara T, Sumikawa K (1998) Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain 14:148–151PubMedCrossRef
18.
Goren A, Yildiz N, Topuz O, Findikoglu G, Ardic F (2010) Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial. Clin Rehabil 24:623–631PubMedCrossRef
19.
Grob D, Humke T, Dvorak J (1995) Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am 77:1036–1041PubMed
20.
Hsu KY, Zucherman JF, Hartjen CA et al (2006) Quality of life of lumbar stenosis-treated patients in whom the X STOP interspinous device was implanted. J Neurosurg Spine 5:500–507PubMedCrossRef
21.
Koc Z, Ozcakir S, Sivrioglu K, Gurbet A, Kucukoglu S (2009) Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine (Phila Pa 1976) 34:985–989CrossRef
22.
Malmivaara A, Slatis P, Heliovaara M et al (2007) Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976) 32:1–8CrossRef
23.
Matsudaira K, Seichi A, Kunogi J et al (2009) The efficacy of prostaglandin E1 derivative in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 34:115–120CrossRef
24.
Pua YH, Cai CC, Lim KC (2007) Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother 53:83–89PubMedCrossRef
25.
Slatis P, Malmivaara A, Heliovaara M et al (2011) Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial. Eur Spine J 20:1174–1181PubMedCentralPubMedCrossRef
26.
Waikakul W, Waikakul S (2000) Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis. J Med Assoc Thai 83:825–831PubMed
27.
Whitman JM, Flynn TW, Childs JD et al (2006) A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine (Phila Pa 1976) 31:2541–2549CrossRef
28.
Yaksi A, Ozgonenel L, Ozgonenel B (2007) The efficiency of gabapentin therapy in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 32:939–942CrossRef
29.
Zucherman JF, Hsu KY, Hartjen CA et al (2004) A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results. Eur Spine J 13:22–31PubMedCentralPubMedCrossRef
30.
Zucherman JF, Hsu KY, Hartjen CA et al (2005) A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine (Phila Pa 1976) 30:1351–1358CrossRef
31.
Thome C, Zevgaridis D, Leheta O et al (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3:129–141PubMedCrossRef
32.
Tomkins-Lane CC, Battie MC (2010) Validity and reproducibility of self-report measures of walking capacity in lumbar spinal stenosis. Spine 35:2097–2102PubMed
33.
Deen HG Jr, Zimmerman RS, Lyons MK et al (2000) Test-retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis. Mayo Clin Proc 75:1002–1007PubMedCrossRef
34.
Yamashita K, Hayashi J, Ohzono K et al (2003) Correlation of patient satisfaction with symptom severity and walking ability after surgical treatment for degenerative lumbar spinal stenosis. Spine 28:2477–2481PubMedCrossRef
35.
Radcliff K, Kepler C, Hilibrand A et al (2013) Epidural steroid injections are associated with less improvement in patients with lumbar spinal stenosis: a subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976) 38:279–291CrossRef
36.
Chou R, Atlas SJ, Stanos SP, Rosenquist RW (2009) Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976) 34:1078–1093CrossRef
37.
Ammendolia C, Stuber K, de Bruin LK et al (2012) Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review. Spine (Phila Pa 1976) 37:E609–E616CrossRef
38.
Friedly J, Chan L, Deyo R (2007) Increases in lumbosacral injections in the Medicare population: 1994 to 2001. Spine (Phila Pa 1976) 32:1754–1760CrossRef
39.
Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265PubMedCentralPubMedCrossRef
40.
Podichetty VK, Varley ES, Lieberman I (2011) Calcitonin treatment in lumbar spinal stenosis: a meta-analysis. Spine (Phila Pa 1976) 36:E357–E364
41.
de Tran QH, Duong S, Finlayson RJ (2010) Lumbar spinal stenosis: a brief review of the nonsurgical management. Can J Anaesth 57:694–703CrossRef
42.
May S, Comer C (2013) Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy 99:12–20PubMedCrossRef
43.
Coronado-Zarco R, Cruz-Medina E, Arellano-Hernandez A, Chavez-Arias D, Leon-Hernandez SR (2009) Effectiveness of calcitonin in intermittent claudication treatment of patients with lumbar spinal stenosis: a systematic review. Spine (Phila Pa 1976) 34:E818–E822CrossRef
44.
Kovacs FM, Urrutia G, Alarcon JD (2011) Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976) 36:E1335–E1351CrossRef
45.
Kabir SM, Gupta SR, Casey AT (2010) Lumbar interspinous spacers: a systematic review of clinical and biomechanical evidence. Spine (Phila Pa 1976) 35:E1499–E1506CrossRef
46.
Gibson JN, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine (Phila Pa 1976) 30:2312–2320CrossRef
47.
Moojen WA, Arts MP, Bartels RH, Jacobs WC, Peul WC (2011) Effectiveness of interspinous implant surgery in patients with intermittent neurogenic claudication: a systematic review and meta-analysis. Eur Spine J 20:1596–1606PubMedCentralPubMedCrossRef
48.
Tomkins CC, Battie MC, Rogers T et al (2009) A criterion measure of walking capacity in lumbar spinal stenosis and its comparison with a treadmill protocol. Spine 34:2444–2449PubMedCrossRef
49.
Kanno H, Ozawa H, Koizumi Y et al (2012) Dynamic change of dural sac cross-sectional area in axial loaded magnetic resonance imaging correlates with the severity of clinical symptoms in patients with lumbar spinal canal stenosis. Spine (Phila Pa 1976) 37:207–213CrossRef
50.
Takahashi K, Miyazaki T, Takino T, Matsui T, Tomita K (1995) Epidural pressure measurements. Relationship between epidural pressure and posture in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 20:650–653CrossRef
51.
Madsen R, Jensen TS, Pope M, Sorensen JS, Bendix T (2008) The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis. Spine (Phila Pa 1976) 33:61–67CrossRef
52.
Conway J, Tomkins CC, Haig AJ (2011) Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures. Spine J 11:816–823PubMedCentralPubMedCrossRef
53.
Stucki G, Cieza A, Melvin J (2007) The international classification of functioning, disability and health (ICF): a unifying model for the conceptual description of the rehabilitation strategy. J Rehabil Med 39:279–285PubMedCrossRef
54.
Tomkins-Lane CC, Haig AJ (2012) A review of activity monitors as a new technology for objectifying function in lumbar spinal stenosis. J Back Musculoskelet Rehabil 25:177–185PubMed
55.
Tremblay MS, Colley RC, Saunders TJ, Healy GN, Owen N (2010) Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab 35:725–740PubMedCrossRef
56.
Tomkins CC, Battie MC (2009) Factors associated with walking capacity in lumbar spinal stenosis. International Society for the Study of the Lumbar Spine Ref Type: Conference Proceeding
57.
Pryce R, Johnson M, Goytan M, Passmore S, Berrington N, Kriellaars D (2012) Relationship between ambulatory performance and self-rated disability in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 37:1316–1323CrossRef
58.
Tomkins-Lane CC, Holz SC, Yamakawa KS et al (2012) Predictors of walking performance and walking capacity in people with lumbar spinal stenosis, low back pain, and asymptomatic controls. Arch Phys Med Rehabil 93:647–653PubMedCentralPubMedCrossRef
59.
Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN (1996) Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976) 21:796–803CrossRef
60.
Tong HC, Carson JT, Haig AJ et al (2006) Magnetic resonance imaging of the lumbar spine in asymptomatic older adults. J Back Musculoskeletal Rehabil 19:67–72
61.
62.
Tomkins-Lane CC, Thomas K, Hu R, Hepler C, Haig AJ (2012) The relationship between performance and traditional outcomes of pain, function and quality of life in people with spondylolisthesis and lumbar spinal stenosis. In: ISSLS conference proceedings, June 2012
63.
Tomkins CC, Haig AJ (2010) The use of computerized activity monitors to assess outcomes of epidural steroid injections for lumbar spinal stenosis. Med Sci Sports Exerc 42(5):149
64.
Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD (2009) Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976) 34:1094–1109CrossRef
65.
Metadata
Title
What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review
Authors
Carlo Ammendolia
Kent Stuber
Christy Tomkins-Lane
Michael Schneider
Y. Raja Rampersaud
Andrea D. Furlan
Carol A. Kennedy
Publication date
01-06-2014
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 6/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3262-6

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