title: What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review.
abstract: OBJECTIVE
  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.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada, cammendolia@mtsinai.on.ca.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ammendolia
authors.forename: Kent
authors.initials: K
authors.lastname: Stuber
authors.forename: Christy
authors.initials: C
authors.lastname: Tomkins-Lane
authors.forename: Michael
authors.initials: M
authors.lastname: Schneider
authors.forename: Y Raja
authors.initials: YR
authors.lastname: Rampersaud
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Furlan
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kennedy
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000588:Amines / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002116:Calcitonin / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D019299:Decompression, Surgical; D004008:Diclofenac / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D026741:Physical Therapy Modalities; D011453:Prostaglandins / Q000627:therapeutic use; D013130:Spinal Stenosis / Q000503:physiopathology*; D016138:Walking / Q000502:physiology*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D050071:Bone Density Conservation Agents; D003509:Cyclohexanecarboxylic Acids; D011453:Prostaglandins; D004008:Diclofenac; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D002116:Calcitonin