1887
Volume 2021, Issue 1
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Lumbosacral spinal stenosis (LSS) is one of the most common causes of back pain and disability. Its treatment varies from surgical to conservative, and the indications for optimal management are not obviously defined. This study aimed to compare the efficacy of caudal epidural injection (CEI) of steroid with and without calcitonin in patients with LSS. This is a randomized, double-blind clinical trial of 31 LSS patients diagnosed between January 1, 2017, to December 30, 2017, who were randomly allocated into two groups. Group A consisted of 17 patients who received C-arm (mobile fluoroscopy)- guided CEI of local anesthetic and steroid, and group B included 14 patients who received C-arm-guided CEI of 100 international unit calcitonin added to local anesthetic and steroid. Outcome measures included the visual analog scale (VAS) for pain during movement and walking distance, Oswestry disability index (ODI), and Quebec back pain disability scale (QBPDS) score, which were obtained from patients before the CEI as a baseline and after the second, fourth, and eighth weeks. Before CEI, no significant differences were found between the two groups, neither in demographic characteristics nor in VAS, ODI, and QBPDS parameters. After CEI, VAS, ODI, and QBPDS improved from baseline through the second, fourth, and eighth weeks in both groups (p < 0.001) without any superiority between the two groups (p = 0.012, 0.078, and 0.019). : CEI of steroid with and without adding calcitonin appears effective in the management of LSS. However, CEI of calcitonin does not appear to have any superiority when compared with steroid injection alone.

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2021-07-06
2021-12-03
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References

  1. Elsheikh NA, Amr YM. Effect of adding calcitonin to translaminar epidural steroid in degenerative lumbar spinal canal stenosis. Pain Phys. 2016; 19:(3):139–46. [PubMed:27008287].
    [Google Scholar]
  2. Hoveidaei AH, Farpour HR, Azarfar H, Raeisi Shahraki H, Owji SH. Evaluation of restless leg syndrome symptoms in patients with lumbosacral canal stenosis comparison with normal population. Br J Neurosurg. 2020; 34:(1):59–61. doi:10.1080/02688697.2019.1691976. [PubMed:31747783].
    [Google Scholar]
  3. Thomé C, Börm W, Meyer F. Degenerative lumbar spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008; 105:(20):373–9. doi:10.3238/arztebl.2008.0373. [PubMed:19626175].
    [Google Scholar]
  4. Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res. 2016; 5:. doi:10.12688/f1000research.8105.2. [PubMed:27408698].
    [Google Scholar]
  5. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014; 371:(1):11–21. doi:10.1056/NEJMoa1313265. [PubMed:24988555].
    [Google Scholar]
  6. Sahin F, Yilmaz F, Kotevoglu N, Kuran B. The efficacy of physical therapy and physical therapy plus calcitonin in the treatment of lumbar spinal stenosis. Yonsei Med J. 2009; 50:(5):683–8. doi:10.3349/ymj.2009.50.5.683. [PubMed:19881973].
    [Google Scholar]
  7. Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do epidural injections provide short- and long-term relief for lumbar disc herniation? A systematic review. Clin Orthop Relat Res. 2015; 473:(6):1940–56. doi:10.1007/s11999–014–3490–4. [PubMed:24515404].
    [Google Scholar]
  8. Peng K, Chen L, Peng J, Xing F, Xiang Z. Effects of calcitonin on lumbar spinal stenosis: a systematic review and meta-analysis. Int J Clin Exp Med. 2015; 8:(2):2536–44. [PubMed:25932199].
    [Google Scholar]
  9. Childs JD, Piva SR. Psychometric properties of the functional rating index in patients with low back pain. Eur Spine J. 2005; 14:(10):1008–12. doi:10.1007/s00586-005-0900-z. [PubMed:15834591].
    [Google Scholar]
  10. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther. 2001; 81:(2):776–88. doi:10.1093/ptj/81.2.776. [PubMed:11175676].
    [Google Scholar]
  11. Koc Z, Ozcakir S, Sivrioglu K, Gurbet A, Kucukoglu S. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine (Phila Pa 1976). 2009; 34:(10):985–9. doi:10.1097/BRS.0b013e31819c0a6b. [PubMed:19404172].
    [Google Scholar]
  12. Winnie AP, Hartman JT, Meyers HL, Ramamurthy S, Barangan V. Pain clinic II: lntradural arid extradural corticosteroids for sciatica. Anesth Analg 1972; 51:(6):990–1003.
    [Google Scholar]
  13. Rosenberg SK, Grabinsky A, Kooser C, Boswell MV. Effectiveness of transforaminal epidural steroid injections in low back pain: a one year experience. Pain Phys. 2002; 5:(3):266–70. [PubMed:16902652].
    [Google Scholar]
  14. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli JT, Freeman ED, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil. 2002; 81:(12):898–905. doi:10.1097/00002060-200212000-00003. [PubMed:12447088].
    [Google Scholar]
  15. Manchikanti L, Cash KA, McManus CD, Pampati V, Fellows B. Results of 2-year follow-up of a randomized, double-blind, controlled trial of fluoroscopic caudal epidural injections in central spinal stenosis. Pain Phys. 2012; 15:(5):371–84. [PubMed:22996849].
    [Google Scholar]
  16. Porter RW, Hibbert C. Calcitonin treatment for neurogenic claudication. Spine (Phila Pa 1976). 1983; 8:(6):585–92. doi:10.1097/00007632-198309000-00004. [PubMed:6359471].
    [Google Scholar]
  17. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Bauer Z, et al. Long-term effects of repeated injections of local anesthetic with or without corticosteroid for lumbar spinal stenosis: A randomized trial. Arch Phys Med Rehabil. 2017; 98:(8):1499–507.e2. doi:10.1016/j.apmr.2017.02.029. [PubMed:28396242].
    [Google Scholar]
  18. Podichetty VK, Varley ES, Lieberman I. Calcitonin treatment in lumbar spinal stenosis: a meta-analysis. Spine (Phila Pa 1976). 2011; 36:(5):E357–64. doi:10.1097/BRS.0b013e318201b834. [PubMed:21325931].
    [Google Scholar]
  19. Eskola A, Alaranta H, Pohjolainen T, Soini J, Tallroth K, Slätis P. Calcitonin treatment in lumbar spinal stenosis: clinical observations. Calcif Tissue Int. 1989; 45:(6):372–4. doi:10.1007/bf02556009. [PubMed:2509029].
    [Google Scholar]
  20. Eskola A, Pohjolainen T, Alaranta H, Soini J, Tallroth K, Slätis P. Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up. Calcif Tissue Int. 1992; 50:(5):400–3. doi:10.1007/bf00296769. [PubMed:1596776].
    [Google Scholar]
  21. Podichetty VK, Segal AM, Lieber M, Mazanec DJ. 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). 2004; 29:(21):2343–9. doi:10.1097/01.brs.0000143807.78082.7f. [PubMed:15507793].
    [Google Scholar]
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