Calcitonin with Translaminar Epidural Steroid in Degenerative Lumbar Spinal Canal Stenosis
Spinal stenosis is the narrowing of spaces in the spine (backbone) which causes pressure on the spinal cord and nerves. About 75% of cases of spinal stenosis occur in the low back (lumbar spine). In most cases, narrowing of the spine associated with stenosis compresses the nerve root, which can cause pain along the back of leg. Its management varies from surgical to conservative, and the indications for ideal management are not clearly defined.
To overcome this problem, study was conducted to evaluate the effect of adding calcitonin to local anesthetic and corticosteroid in epidural injection for patients suffering from degenerative lumbar spinal canal stenosis.
In randomized double-blind clinical trial, 132 patients with degenerative spinal canal stenosis were randomly allocated into 2 groups. Group I received C-arm guided epidural injection of local anesthetic and corticosteroid and Group II received 50 international unit calcitonin added to the mixture of local anesthetic and corticosteroid. In the trial, both groups received 2 sets of injections, one week apart. Visual analogue scale for pain during movement and walking distance until incidence of neurogenic claudication have been used for pain assessment and Oswestry Low Back Pain Disability Questionnaire and analgesic consumption were also evaluated for one year.
After randomized trial, both groups showed comparable benefits regarding improvement in pain intensity, walking distance, Oswestry scale and analgesic consumption during the first month follow-up period. These beneficial effects continued in calcitonin group for one year. However, patients in the present study would be graded as having mild or at worst moderate stenosis. Adding calcitonin to epidural steroid and local anesthesia alone appeared to be more effective than epidural steroid and local anesthesia in managing spinal canal stenosis regarding increased walking distance, better Oswestry scale, diminished pain intensity and perception of paresthesia and less analgesic consumption.
After analysis, the present study did not examine the efficacy of epidural calcitonin in severe spinal canal stenosis and did not stratified the results according to degree of stenosis. So, epidural calcitonin may be considered as a new therapeutic modality in the management of pain in spinal canal stenosis.