Effect of Adding Calcitonin to Translaminar Epidural Steroid in Degenerative Lumbar Spinal Canal Stenosis

Abstract

Background: Spinal canal stenosis is one of the most common causes of low back pain and disability. Its management varies from surgical to conservative, and the indications for ideal management are not clearly defined. Objectives: This study was conducted to evaluate the effect of adding calcitonin to local anesthetic and corticosteroid in epidural injection for patients suffering from degenerative lumbar spinal canal stenosis. Study Design: Randomized double-blind clinical trial. Setting: Hospital outpatient setting. Methods: One hundred thirty-two patients with degenerative spinal canal stenosis were randomly allocated into 2 groups. Group I received C-arm guided epidural injection of local anesthetic and corticosteroid and Group II received 50 international unit calcitonin added to the mixture of local anesthetic and corticosteroid. Both groups received 2 sets of injections, one week apart. Visual analogue scale for pain during movement and walking distance until incidence of neurogenic claudication have been used for pain assessment, and Oswestry Low Back Pain Disability Questionnaire and analgesic consumption were evaluated for one year. Results: Both groups showed comparable benefits regarding improvement in pain intensity, walking distance, Oswestry scale, and analgesic consumption during the first month follow-up period. These beneficial effects continued in calcitonin group for one year. Limitations: The present study patients would be graded as having mild or at worst moderate stenosis. So, the present study did not examine the efficacy of epidural calcitonin in severe spinal canal stenosis and did not stratify the results according to degree of stenosis which would also have been useful in determining the validity of calcitonin in different degrees of stenosis. Conclusion: Adding calcitonin to epidural steroid and local anesthetic injection seems to be more effective than epidural steroid and local anesthesia alone in management of spinal canal stenosis regarding increased walking distance, better Oswestry scale, diminished pain intensity and perception of paresthesia, and less analgesic consumption, all the above mentioned benefits continued up to one year. So, epidural calcitonin may be considered as a new therapeutic modality in the management of pain in spinal canal stenosis. Key words: Calcitonin, epidural steroid, lumbar, spinal canal stenosis