European Spine Journal

, Volume 23, Issue 6, pp 1282–1301

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

  • Carlo Ammendolia
  • Kent Stuber
  • Christy Tomkins-Lane
  • Michael Schneider
  • Y. Raja Rampersaud
  • Andrea D. Furlan
  • Carol A. Kennedy
Review Article

DOI: 10.1007/s00586-014-3262-6

Cite this article as:
Ammendolia, C., Stuber, K., Tomkins-Lane, C. et al. Eur Spine J (2014) 23: 1282. doi:10.1007/s00586-014-3262-6



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


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.


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.


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.


Walking ability Neurogenic claudication Lumbar spinal stenosis Systematic review Interventions 



Randomized controlled trial


Self paced walking test


Zurich claudication questionnaire


Oswestry disability index


Grades of recommendations, assessment, development and evaluation

Supplementary material

586_2014_3262_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 24 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Carlo Ammendolia
    • 1
    • 2
    • 11
  • Kent Stuber
    • 6
  • Christy Tomkins-Lane
    • 10
  • Michael Schneider
    • 9
  • Y. Raja Rampersaud
    • 5
  • Andrea D. Furlan
    • 3
    • 8
    • 11
  • Carol A. Kennedy
    • 4
    • 7
    • 11
  1. 1.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  2. 2.Department of MedicineMount Sinai HospitalTorontoCanada
  3. 3.Department of MedicineUniversity of TorontoTorontoCanada
  4. 4.Department of Physical TherapyUniversity of TorontoTorontoCanada
  5. 5.Department of Surgery, Divisions of Orthopaedic and NeurosurgeryToronto Western Hospital, University of TorontoTorontoCanada
  6. 6.Department of Graduate Education and ResearchCanadian Memorial Chiropractic CollegeTorontoCanada
  7. 7.Mobility Program Clinical Research UnitSt. Michael’s HospitalTorontoCanada
  8. 8.Toronto Rehabilitation InstituteTorontoCanada
  9. 9.Department of Physical Therapy, School of Health and Rehabilitation SciencesUniversity of PittsburghPittsburghUSA
  10. 10.Department of Physical Education and Recreation StudiesMount Royal UniversityCalgaryCanada
  11. 11.Institute for Work and HealthTorontoCanada

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