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

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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.

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Abbreviations

RCT:

Randomized controlled trial

SPWT:

Self paced walking test

ZCQ:

Zurich claudication questionnaire

ODI:

Oswestry disability index

GRADE:

Grades of recommendations, assessment, development and evaluation

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Acknowledgments

We would like to thank Rachel Couban, librarian for the Cochrane Back Review Group for her assistance in developing the search strategy and retrieving relevant articles. The principal investigator (corresponding author) is supported by a grant from the Canadian Chiropractic Research Foundation.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Carlo Ammendolia

  2. Department of Medicine, Mount Sinai Hospital, Toronto, Canada

    Carlo Ammendolia

  3. Department of Medicine, University of Toronto, Toronto, Canada

    Andrea D. Furlan

  4. Department of Physical Therapy, University of Toronto, Toronto, Canada

    Carol A. Kennedy

  5. Department of Surgery, Divisions of Orthopaedic and Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada

    Y. Raja Rampersaud

  6. Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Canada

    Kent Stuber

  7. Mobility Program Clinical Research Unit, St. Michael’s Hospital, Toronto, Canada

    Carol A. Kennedy

  8. Toronto Rehabilitation Institute, Toronto, Canada

    Andrea D. Furlan

  9. Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA

    Michael Schneider

  10. Department of Physical Education and Recreation Studies, Mount Royal University, Calgary, Canada

    Christy Tomkins-Lane

  11. Institute for Work and Health, Toronto, Canada

    Carlo Ammendolia, Andrea D. Furlan & Carol A. Kennedy

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  1. Carlo Ammendolia
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  2. Kent Stuber
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Correspondence to Carlo Ammendolia.

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Ammendolia, C., Stuber, K., Tomkins-Lane, C. et al. What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review. Eur Spine J 23, 1282–1301 (2014). https://doi.org/10.1007/s00586-014-3262-6

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  • DOI: https://doi.org/10.1007/s00586-014-3262-6

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