Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication
Information
- DOI:
- https://doi.org/10.1002/14651858.CD010712Copy DOI
- Database:
-
- Cochrane Database of Systematic Reviews
- Version published:
-
- 30 August 2013see what's new
- Type:
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- Intervention
- Stage:
-
- Review
- Cochrane Editorial Group:
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Cochrane Back and Neck Group
- Copyright:
-
- Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article metrics
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Cited by:
Authors
Contributions of authors
Conception and design: C Ammendolia, KJ Stuber
Analysis and interpretation of the data: C Ammendolia
Drafting of the review: all members
Critical revision of the article for important intellectual content: all members
Final approval of the article: all members
Statistical Expertise: A Furlan
Administrative, technical, or logistical support:
Collection and assembly of data: KJ Stuber, ER Rok
Sources of support
Internal sources
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No sources of support supplied
External sources
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Canadian Chiropractic Research Foundation, Canada.
Declarations of interest
The principal author received funding from the Canadian Chiropractic Research Foundation.
Acknowledgements
This review is adapted from the original version, which was published in Spine (Ammendolia 2012).
The authors thank Rachel Couban, Trials Search Coordinator for the Cochrane Back Review Group, for her assistance in developing the search strategy and retrieving relevant articles.
Version history
| Published | Title | Stage | Authors | Version |
| 2013 Aug 30 | Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication | Review | Carlo Ammendolia, Kent J Stuber, Elisabeth Rok, Raja Rampersaud, Carol A Kennedy, Victoria Pennick, Ivan A Steenstra, Linda K de Bruin, Andrea D Furlan | |
Notes
There is no published protocol for this review. It was initially published in Spine (Ammendolia 2012) and then converted to a Cochrane Review. Although the authors conducted their review in accordance with the Cochrane Back Review Group method guidelines (Furlan 2009), they did not have access to complete risk of bias information at the time of publication. This information will be incorporated into the review when it is updated in two years' time.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Analgesia, Epidural;
- Calcitonin [administration & dosage];
- Exercise Therapy [methods];
- Intermittent Claudication [etiology, *therapy];
- Leg [blood supply, innervation];
- *Lumbar Vertebrae;
- Neuralgia [etiology, *therapy];
- Prostaglandins [administration & dosage];
- Randomized Controlled Trials as Topic;
- Spinal Stenosis [complications, *therapy];
Medical Subject Headings Check Words
Aged; Female; Humans; Male; Middle Aged;
PICOs
Selection process of included articles.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Forest plot of comparison: 1 Direct decompression ± fusion versus multimodal nonoperative care for Oswestry Disability Index, outcome: 1.1 Oswestry Disability Index.
Comparison 1 Direct Decompression ± fusion versus multimodal nonoperative care for Oswestry Disability Index, Outcome 1 Oswestry Disability Index.
| Comparisons and trials | Risk of bias | GRADE assessment and outcomes/measures (walking ability, pain, function, and quality of life) at each follow‐up point | ||||||||
| Consistency | Directness | Precision | Selective reporting | Immediate | Short‐term | Intermediate | Long‐term | Quality of the evidence | ||
| Calcitonin | ||||||||||
| Calcitonin injection versus placebo injection | ||||||||||
| High High | No No | Yes Yes | No No | Yes Yes |
| = TWT = VAS | = TWT = VAS | = TWT = VAS | +000 +000 | |
| High | No | Yes | No | Yes |
| ? distance walked | ? distance walked |
| +000 | |
| High High | No No | Yes Yes | No No | Yes Yes |
| = distance walked = VAS |
|
| +000 +000 | |
| Calcitonin nasal spray versus placebo nasal spray | ||||||||||
| High High High High | No No No No | Yes Yes Yes | No No No No | Yes |
| = distance walked = time walked = SF‐36 = VAS |
|
| +000 +000 +000 +000 | |
| High High High High High | No No No No No | Yes Yes Yes Yes Yes | No No No No No |
|
| = Shuttle walk = VAS leg = VAS back = ODI = global |
|
| +000 +000 +000 +000 +000 | |
| Calcitonin nasal spray plus physical therapy versus paracetamol plus physical therapy | ||||||||||
| High High High | No No No | Yes Yes Yes | No No No |
|
| = distance walked = VAS = RMDI |
|
| +000 +000 +000 | |
| Oral medication | ||||||||||
| Oral prostaglandin versus etodolac (NSAID) | ||||||||||
|
| Low Low Low Low Low | No No No No No | Yes Yes Yes Yes Yes | No No No No No | Yes |
| > distance walked ? SF‐36 = LBP > Leg pain > global |
|
| ++00 +000 ++00 ++00 ++00 |
| Methylocobalamin (vitamin B12) plus conservative care versus conservative care | ||||||||||
| High | No | Yes | No | Yes | > distance walked | > distance walked | +000 | |||
| Gabapentin versus placebo | ||||||||||
|
| High High High | No No No | Yes Yes Yes | No No No |
|
|
| > distance walked = VAS (1‐2 months) > VAS (3 months) | > distance walked > VAS | +000 +000 +000 |
| Physical therapy | ||||||||||
| Exercise plus ultrasound versus exercise plus sham ultrasound | ||||||||||
| Low Low Low Low | No No No No | Yes Yes Yes Yes | No No No No |
|
| = TWT = VAS back = VAS leg = ODI |
|
| ++00 ++00 ++00 ++00 | |
| Exercise plus ultrasound versus no treatment | ||||||||||
| Low Low Low Low | No No No No | Yes Yes Yes Yes | No No No No |
|
| = TWT = VAS back > VAS leg > ODI |
|
| ++00 ++00 ++00 ++00 | |
| Exercise plus sham ultrasound versus no treatment | ||||||||||
| Low Low Low Low | No No No No | Yes Yes Yes Yes | No No No No |
|
| = TWT = VAS back > VAS leg > ODI |
|
| ++00 ++00 ++00 ++00 | |
| Inpatient physical therapy versus home exercise program plus oral diclofenac | ||||||||||
| High High High High | No No No No | Yes Yes Yes Yes | No No No No | Yes |
| = TWT > VAS > RMDI > NHP | = TWT = VAS = RMDI = NHP |
| +000 +000 +000 +000 | |
| Unweighted treadmill walking plus exercise versus cycling plus exercise | ||||||||||
| Low Low Low Low Low | No No No No No | Yes Yes Yes Yes Yes | No No No No No |
|
| = distance walked = ODI = RMDI = VAS = global |
|
| ++00 ++00 ++00 ++00 ++00 | |
| Manual therapy, exercise and unweighted treadmill versus flexion exercise, walking and sham ultrasound | ||||||||||
| High High High High | No No No No | Yes Yes Yes Yes | No No No No |
|
| = TWT > global = ODI = NPRS |
| = global | +000 +000 +000 +000 | |
| Epidural injection | ||||||||||
| Translaminar epidural steroid injections versus placebo injections | ||||||||||
| High | No | Yes | No | = global | =global | +000 | ||||
| Translaminar epidural steroids plus epidural block versus placebo injections | ||||||||||
| High | No | Yes | No |
| > distance walked | = distance walked |
|
| +000 | |
| Translaminar epidural steroids plus epidural block versus epidural block injections | ||||||||||
| High | No | Yes | No |
| = distance walked | = distance walked |
|
| +000 | |
| Translaminar epidural block versus placebo | ||||||||||
| High | No | Yes | No |
| > distance walked | = distance walked |
|
| +000 | |
| Intralaminar epidural steroid plus epidural block versus home exercise program plus oral diclofenac | ||||||||||
| High High High High | No No No No | Yes Yes Yes Yes | No No No No | Yes Yes Yes Yes |
| = TWT > VAS > RMDI > NHP | = TWT = VAS = RMDI = HNP |
| +000 +000 +000 +000 | |
| Intralaminar epidural steroid plus epidural block versus inpatient physical therapy | ||||||||||
| High High High High | No No No No | Yes Yes Yes Yes | No No No No | Yes Yes Yes Yes |
| = TWT > VAS > RMDI > NHP | = TWT = VAS = RMDI = HNP |
| +000 +000 +000 +000 | |
| Caudal epidural steroids versus placebo injections | ||||||||||
| High | No | Yes | No |
| = global |
|
| = global | +000 | |
| Multimodal nonoperative treatment | ||||||||||
| Indirect decompression using interspinous spacer (X‐Stop) versus multimodal nonoperative care for degenerative spondylolisthesis | ||||||||||
| Zucherman 2004, Anderson 2006 | High | No | Yes | No | SR (short & intermediate) |
| > ZCQ | > ZCQ | > ZCQ | +000 |
| Indirect decompression using interspinous spacer (X_Stop) versus multimodal nonoperative care | ||||||||||
| Zucherman 2004, 2005, Hsu 2006 | High | No No | Yes Yes | No No | SR SR |
| > ZCQ > SF‐36 | > ZCQ > SF‐36 | > ZCQ > SF‐36 | +000 +000 |
| Direct decompression ± fusion versus multimodal nonoperative care for degenerative spondylolisthesis | ||||||||||
| High High High High High | No No No No No | Yes Yes Yes Yes Yes | No No No No No |
|
| = SF‐36 = ODI = LBPBS = LPBI = SBS | = SF‐36 = ODI = LBPBS = LPBI = SBS | = SF‐36 = ODI = LBPBS = LPBI = SBS | +000 +000 +000 +000 +000 | |
| Direct decompression ± fusion versus multimodal nonoperative care | ||||||||||
| High High | No No | Yes Yes | No No |
|
| ?* pain severity | ?* global | ?* pain severity ? global | +000 +000 | |
| Low Low Low Low Low Low | No No No No No No | Yes Yes Yes Yes Yes Yes | No No No No No No |
|
| = TWT = SW > VAS leg walk > VAS leg > VAS LB ODI (see Figure 4) | = TWT = SW > VAS leg walk > VAS leg > VAS LB ODI (see Figure 4) | ++00 ++00 ++00 ++00 ++00 +000 | ||
| High High High High High High | No No No No No No | Yes Yes Yes Yes Yes Yes | No No No No No No |
|
| = SF‐36 BP = SF‐36 PF = LBPBS = LPBI = SBS = ODI | = SF‐36 BP = SF‐36 PF = LBPBS = LPBI = SBS ODI (see Figure 4) | > SF‐36 BP** = SF‐36 PF = LBPBS = LPBI = SBS ODI (Figure 4) | +000 +000 +000 +000 +000 +000 | |
| Follow‐up points: Immediate = up to 1 week, short‐term = >1 week ‐ 3 months, intermediate = 3 months ‐ 1 year, long‐term = > 1 year > statistically significant favouring intervention (first comparison), < statistically significant favouring control (second comparison), = no statistically significant difference between intervention and control groups TWT = Treadmill Walking Test, VAS = Visual Analog Scale for Pain Intensity, RMDI = Roland‐Morris Back Disability Index, NHP = Nottingham Health Profile, Global = Patient Perceived Improvement, SR = Selective Reporting, ODI = Oswestry Back Disability Index, ? = insufficient data, LBP = Low back Pain Severity Scale, Leg pain = Leg Pain Severity Scale, ? SF‐36 = No data on overall score, improvement in some subscales, NPRS = Numeric Pain Rating Scale, SF‐36 BP = SF‐36 Bodily Pain Subscale, SF‐36‐ PF = SF‐36 Physical Function Subscale, LBPBS ‐ Low Back Pain Bothersome Scale, LPBI = Leg Pain Bothersome Index, SBS ‐ Stenosis Bothersome Scale, SW = Subjective Walking, VAS leg = Visual Analog Scale for Leg Pain, VAS LB = Visual Analog Scale for Low Back Pain, VAS leg walking = Visual Analog Scale for Leg pain while walking, ?* = no between group statistical comparisons, ** = SF‐36 BP significantly better at 2 years but not 4 years. GRADE evidence: +000 = Very low quality evidence, ++00 = Low quality evidence, +++0 = Moderate quality evidence, ++++ = High quality evidence | ||||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Oswestry Disability Index Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.1 6 Months | 2 | 349 | Mean Difference (IV, Random, 95% CI) | ‐3.66 [‐10.12, 2.80] |
| 1.2 12 Months | 2 | 340 | Mean Difference (IV, Random, 95% CI) | ‐6.17 [‐15.02, 2.67] |
| 1.3 24 Months | 2 | 315 | Mean Difference (IV, Random, 95% CI) | ‐4.43 [‐7.91, ‐0.96] |
