title: Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To systematically review the evidence for the effectiveness of nonoperative treatment of lumbar spinal stenosis with neurogenic claudication.
  
  
  BACKGROUND
  Neurogenic claudication can significantly impact functional ability, quality of life, and independence in the elderly. METHODS.: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and ICL databases up to January 2011 for randomized controlled trials published in English, in which at least 1 arm provided data on nonoperative treatments. Risk of bias in each study was independently assessed by 2 reviewers using 12 criteria. Quality of the evidence was evaluated using Grades of Recommendations, Assessment, Development, and Evaluation (GRADE).
  
  
  RESULTS
  From the 8635 citations screened, 56 were assessed and 21 trials with 1851 participants were selected. There is very low-quality evidence from 6 trials that calcitonin is no better than placebo or paracetamol, regardless of mode of administration or outcome. From single small trials, there is low-quality evidence that prostaglandins, and very low-quality evidence that gabapentin or methylcobalamin, improve walking distance. There is very low-quality evidence from a single trial that epidural steroid injections improve pain, function, and quality of life up to 2 weeks compared with home exercise or inpatient physical therapy. There is low-quality evidence from a single trial that exercise is of short-term benefit for leg pain and function compared with no treatment. There is low- and very low-quality evidence from 6 trials that multimodal nonoperative treatment is less effective than indirect or direct surgical decompression with or without fusion.
  
  
  CONCLUSIONS
  Moderate- and high-GRADE evidence for nonoperative treatment is lacking and thus prohibiting recommendations to guide clinical practice. Given the expected exponential rise in the prevalence of lumbar spinal stenosis with neurogenic claudication, large high-quality trials are urgently needed.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. c.ammendolia@utoronto.ca
authors.forename: Carlo
authors.initials: C
authors.lastname: Ammendolia
authors.forename: Kent
authors.initials: K
authors.lastname: Stuber
authors.forename: Linda K
authors.initials: LK
authors.lastname: de Bruin
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Furlan
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kennedy
authors.forename: Yoga Raja
authors.initials: YR
authors.lastname: Rampersaud
authors.forename: Ivan A
authors.initials: IA
authors.lastname: Steenstra
authors.forename: Victoria
authors.initials: V
authors.lastname: Pennick
mesh_terms: D002116:Calcitonin / Q000008:administration & dosage; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D026741:Physical Therapy Modalities; D011453:Prostaglandins / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013130:Spinal Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D011453:Prostaglandins; D002116:Calcitonin