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

Luiz Claudio L Rodrigues,Jamil Natour

doi:10.1186/1477-5751-13-13

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.

Highlights

Corticoids have potent anti-inflammatory effects, which may help in relieving pain and dysfunction associated with lumbar canal stenosis
The oral corticoid regimen tested in this study provided no significant pain relief or benefits to motor function in patients with lumbar canal stenosis
We do not know how effective this particular dose regimen was at decreasing inflammation around the stenosis sites; we cannot exclude a beneficial effect of other more efficacious and tolerable anti-inflammatory drugs. This placebo-controlled study indicates that a tapering regimen of oral corticoids, starting at 1 mg/kg daily, is not effective regarding pain, function, quality of life, analgesic consumption or satisfaction with the treatment in patients with lumbar canal stenosis when compared to placebo

Summary

Introduction

Corticoids have potent anti-inflammatory effects, which may help in relieving pain and dysfunction associated with lumbar canal stenosis. Symptomatic lumbar canal stenosis is characterized by degenerative alterations in several structures of the vertebral segment, including the zygapophyseal joint, flavum, articular capsule, and intervertebral disc These alterations decrease the vertebral canal area, resulting in pressure on the neural structures [1] that is clinically manifested as low back pain [2] and lower limb pain that worsens while walking and improves with rest, a presentation called neurogenic claudication [3]. Because spinal stenosis most frequently affects the elderly, a patient group with a high surgical complication rate, an oral regimen can dramatically improve overall treatment safety. To this end, we assessed the efficacy of oral corticoids for the treatment of lumbar canal stenosis

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Discussion

Conclusion