A double-blind, randomized controlled, prospective trial assessing the effectiveness of oral corticoids in the treatment of symptomatic lumbar canal stenosis

Abstract

BackgroundCorticoids have potent anti-inflammatory effects, which may help in relieving pain and dysfunction associated with lumbar canal stenosis. We assessed the effectiveness of a decreasing-dose regimen of oral corticoids in the treatment of lumbar canal stenosis in a prospective, double-blind, randomized, placebo-controlled trial.ResultsSixty-one patients with lumbar canal stenosis (50–75 years; canal area < 100 mm2 at L3/L4, L4/L5, and/or L5/S1on magnetic resonance imaging; and claudication within 100 m were electronically randomized to an oral corticoid group (n = 31) or a placebo group (n = 30). The treatment group received 1 mg/kg of oral corticoids daily, with a dose reduction of one-third per week for 3 weeks. Patients and controls were assessed by the Short Form 36 Health Survey, Roland–Morris Questionnaire, 6-min walk test, visual analog scale, and a Likert scale. All instruments showed similar outcomes for the corticoid and placebo groups (P > 0.05). Obese patients exhibited more severe symptoms compared with non-obese patients. L4/L5 stenosis was associated with more severe symptoms compared with stenosis at other levels.ConclusionThe oral corticoid regimen used in this study was not effective in the treatment of lumbar canal stenosis.

Lumbar Spinal Stenosis – From Epidemiology to Rehabilitation

“…Tako, na primjer, u recentnom istraživanju nije dokazana razlika poslije 12 tjedana praćenja nakon primjene prednizona ili placeba, u praćenju od 3 tjedna u mjerama intenziteta boli, 6-minutnog testa hoda, Roland-Morrisova upitnika za funkcionalnu sposobnost u kroničnoj križobolji ili u bilo kojoj od domena generičkoga složenog upitnika SF-36. 99 Intervencijski minimalno invazivni zahvati kod stenoze spinalnog kanala slabinske regije U bolesnika koji ne odgovore zadovoljavajuće na mjere i postupke konzervativnog liječenja na raspolaganju su one invazivnog liječenja, odnosno kirurškoga. Podatci govore da će u razdoblju od deset godina samo 20 do 40% osoba koje imaju blagu do umjerenu stenozu spinalnog kanala slabinske regije završiti na kirurškom liječenju.…”

Kronik bel-boyun ağrılı hastada adjuvan analjezikler

“…[57][58][59] Kronik bel-boyun ağrılarında, epidural kortikosteroid enjeksiyonunun etkinliği gös-terilmiştir. [60][61][62] …”

Lumbar Spinal Stenosis, Clinical Presentation, Diagnosis, and Treatment

“…Corticosteroids are also used indiscriminately. The idea is that there is an inflammatory process associated with the mechanical compression that could benefit from the medication, but this theory was not proven by Natour's study [47].…”

“…The recommended activities include manual therapy, strengthening, and walking training, as well as exercises that improves proprioception. In addition, weight loss is important, because obese patients have been described to have a worse prognosis [47]. Cycling is a very much recommended activity, not only because patients tolerate it well, but it also allows them to improve their conditioning and does not impact other joints that may also be degenerated, such as the hip and the knee [50].…”

“…Peridural corticosteroids are another type of non-surgical treatment for narrow lumbar spinal canal syndrome, as opposed to oral corticosteroids, which were shown to be ineffective for this condition [47]. Peridural corticosteroids have some advantages, which are discussed below.…”