Yonsei Med J.  2009 Oct;50(5):683-688. 10.3349/ymj.2009.50.5.683.

The Efficacy of Physical Therapy and Physical Therapy Plus Calcitonin in the Treatment of Lumbar Spinal Stenosis

Affiliations
  • 1Department of Physical and Rehabilitation Medicine, Sisli Etfal Training and Research Hospital, Istanbul, Turkey. drfusunsahin@yahoo.com.tr

Abstract

PURPOSE
The aim of our study was to compare the efficacy of physical therapy alone and in combination with calcitonin in patients with neurogenic claudication (NC). MATERIALS AND METHODS: In this single blind, and randomized study, patients with lumbar spinal canal stenosis who were diagnosed by clinical findings and MRI and having NC were included. Patients were observed for 8 weeks and evaluated before and after treatment. Patients were randomized between the salmon calcitonin 200 U/day + physical therapy (n = 23) (Group 1) and paracetamol 1,500 mg/day + physical therapy (n = 22) (Group 2) treatment groups. Both groups received the same physical therapy (interferential current + hot pack + short wave diathermy) and exercise protocol. The association of various clinical and functional parameters was assessed statistically by using paired and unpaired t test, chi square test and McNemar's test. p < 0.05 indicated statistical significant. RESULTS: Mean age of the patients in Group 1 was 57.6 +/- 11.2 and in Group 2 54.5 +/- 10.6 years. Before treatment, there were no significant differences between groups with respect to age, body mass index, spinal axial diameter, Visual Analogue Scale (VAS), spinal mobility, functional status and walking distance (p > 0.05). After 8 weeks of treatment, both groups benefited significantly with respect to VAS, functional status and walking distance (p < 0.001). There was no statistically significant difference between groups (p > 0.05). CONCLUSION: In 45 patients with lumbar spinal stenosis who received 8 weeks of treatment, concomitant use of calcitonin with physical therapy and exercise did not have any benefical effect on the patient's pain, functional status, lumbar mobility and walking distance.

Keyword

Lumbar spinal stenosis; calcitonin; physical therapy

MeSH Terms

Acetaminophen/therapeutic use
Aged
Calcitonin/administration & dosage/*therapeutic use
Exercise Therapy
Female
Humans
*Lumbar Vertebrae
Male
Middle Aged
Pain Measurement
*Physical Therapy Modalities
Spinal Stenosis/*drug therapy
Treatment Outcome

Figure

  • Fig. 1 Level of disease in patients.


Cited by  1 articles

The Evidence for Nonoperative Treatment of Lumbar Spinal Diseases
Hak Sun Kim, Dong Ki Ahn, Hyung Yun Seo, Chang Soo Kim, Myung Jin Kim
J Korean Soc Spine Surg. 2019;26(4):178-190.    doi: 10.4184/jkss.2019.26.4.178.


Reference

1. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine (Phila Pa 1976). 2000. 25:1424–1435. discussion 1435-6.
2. Porter RW. Spinal stenosis and neurogenic claudication. Spine (Phila Pa 1976). 1996. 21:2046–2052.
Article
3. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976). 1992. 17:1–8.
4. Shönström N, Lindahl S, Willén J, Hansson T. Dynamic changes in the dimensions of the lumbar spinal canal: an experimental study in vitro. J Orthop Res. 1989. 7:115–121.
Article
5. Schonstrom NS, Bolender N, Spengler DM. The pathomorphology of spinal stenosis as seen on CT scans of the lumbar spine. Spine (Phila Pa 1976). 1985. 10:806–811.
Article
6. Fritz JM, Delitto A, Welch WC, Erhard RE. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Arch Phys Med Rehabil. 1998. 79:700–708.
Article
7. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990. 72:403–408.
Article
8. Fritz JM, Erhard RE, Vignovic M. A nonsurgical treatment approach for patients with lumbar spinal stenosis. Phys Ther. 1997. 77:962–973.
Article
9. Simotas AC, Dorey FJ, Hansraj KK, Cammisa F Jr. Nonoperative treatment for lumbar spinal stenosis: clinical outcome results and 3-year survivorship analysis. Spine (Phila Pa 1976). 2000. 25:197–203.
10. Bodack MP, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Relat Res. 2001. 384:144–152.
Article
11. Porter RW, Hibbert C. Calcitonin treatment for neurogenic claudication. Spine (Phila Pa 1976). 1983. 8:589–592.
Article
12. Porter RW, Miller CG. Neurogenic claudication and root claudication treated with calcitonin. A double-blind trial. Spine. 1988. 13:1061–1064.
Article
13. Eskola A, Alaranta H, Pohjolainen T, Soini J, Tallroth K, Slätis P. Calcitonin treatment in lumbar spinal stenosis: clinical observations. Calcif Tissue Int. 1989. 45:372–374.
Article
14. Baker AR, Collins TA, Porter RW, Kidd C. Laser Doppler study of porcine caudate equina blood flow. The effect of electrical stimulation of the rootlets during single and double site, low pressure compression of the cauda equina. Spine. 1995. 20:660–664.
Article
15. Penning L, Wilmink JT. Posture-dependent bilateral compression of L4 or L5 nerve roots in facet hypertrophy. A dynamic CT-myelographic study. Spine (Phila Pa 1976). 1987. 12:488–500.
Article
16. Takahashi K, Miyazaki T, Takino T, Matsui T, Tomita K. Epidural pressure measurements. Relationship between epidural pressure and posture in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 1995. 20:650–653.
17. Katz JN, Dalgas M, Stucki G, Lipson SJ. Diagnosis of lumbar spinal stenosis. Rheum Dis Clin North Am. 1994. 20:471–483.
Article
18. Dyck P, Doyle JB Jr. "Bicycle test" of van Gelderen in diagnosis of intermittent cauda equina compression syndrome. Case report. J Neurosurg. 1977. 46:667–670.
Article
19. Tuite GF, Stern JD, Doran SE, Papadopoulos SM, McGillicuddy JE, Oyedijo DI, et al. Outcome after laminectomy for lumbar spinal stenosis. Part I: clinical correlations. J Neurosurg. 1994. 81:699–706.
20. Küçükdeveci AA, Tennant A, Elhan AH, Niyazoglu H. Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain. Spine (Phila Pa 1976). 2001. 26:2738–2743.
Article
21. Fritz JM, Erhard RE, Delitto A, Welch WC, Nowakowski PE. Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis. J Spinal Disord. 1997. 10:410–416.
Article
22. Johnsson KE, Rosén I, Udén A. The natural course of lumbar spinal stenosis. Clin Orthop Relat Res. 1992. 279:82–86.
Article
23. Johnsson KE, Udén A, Rosén I. The effect of decompression on the natural course of spinal stenosis. A comparison of surgically treated and untreated patients. Spine (Phila Pa 1976). 1991. 16:615–619.
24. Gunzburg R, Szpalski M. The conservative surgical treatment of lumbar spinal stenosis in the elderly. Eur Spine J. 2003. 12:Suppl 2. S176–S180.
Article
25. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleâs F. Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. . Spine (Phila Pa 1976). 2000. 25:1424–1435.
26. Jolles BM, Porchet F, Theumann N. Surgical treatment of lumbar spinal stenosis. Five-year follow-up. J Bone Joint Surg Br. 2001. 83:949–953.
27. Tadokoro T, Miyamoto H, Sumi M, Shimornura T. The prognosis of conservative treatmants for lumbar spinal stenosis; analysis of patients over 70 years of age. Spine (Phila Pa 1976). 2005. 30:2458–2463.
28. Sengupta DK, Herkowitz HN. Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthop Clin North Am. 2003. 34:281–295.
29. Vo AN, Kamen LB, Shih VC, Bitar AA, Stitik TP, Kaplan RJ. Rehabilitation of orthopedic and rheumatologic disorders. 5. Lumbar spinal stenosis. Arch Phys Med Rehabil. 2005. 86:S69–S76.
30. Bridwell KH. Lumbar spinal stenosis. Diagnosis, management, and treatmant. Clin Geriatr Med. 1994. 10:677–701.
31. Onel D, Sari H, Dönmez C. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention? Spine (Phila Pa 1976). 1993. 18:291–298.
32. Simotas AC, Dorey FJ, Hansraj KK, Cammisa F Jr. Nonoperative treatment for lumbar spinal stenosis. Clinical and outcome results and a 3-year survivorship analysis. Spine (Phila Pa 1976). 2000. 25:197–203.
33. Porter RW, Hibbert C. Calcitonin treatment for neurogenic claudication. Spine (Phila Pa 1976). 1983. 8:585–592.
Article
34. Eskola A, Pohjolainen T, Alaranta H, Soini J, Tallroth K, Slätis P. Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up. Calcif Tissue Int. 1992. 50:400–403.
Article
35. Podichetty VK, Segal AM, Lieber M, Mazanec DJ. Effectiveness of salmon calcitonin nasal spray in the treatment of lumbar canal stenosis: a double-blind, randomized, placebo-controlled, parallel group trial. Spine (Phila Pa 1976). 2004. 29:2343–2349.
Article
36. Atlas SJ, Keller RB, Robson D, Deya RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976). 2000. 25:556–562.
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