Department of Spinal Rehabilitation, Instituto Nacional de Rehabilitación (National Institute for Rehabilitation) Mexico City, Mexico.
Spine (Phila Pa 1976). 2009 Oct 15;34(22):E818-22. doi: 10.1097/BRS.0b013e3181afe60a.
Systematic review.
Analyze the level of evidence in the effectiveness of calcitonin on the treatment of neurogenic claudication in patients with lumbar spinal stenosis.
One of the most disabling features of lumbar spinal stenosis is neurogenic claudication. There have been proposed different drug therapies for it. The recommendation for calcitonin use in these patients has been sustained on autocontrolled clinical trial (Streifler et al, Neurol Neurosurg Psychiatry 1989;52:543-4), which only included 6 patients.
We performed a search on electronic databases that included Medline and Embase; we recovered 10 original articles, of which only 4 fulfilled the RCT criteria. These articles were reviewed independent and blinded way by 6 previously capacitated reviewers to extract data and score a quality of them by the criteria of Cochrane Handbook (1996) with maximum score of 1.00 and minimum score of 0.33.
Score quality vary in the 4 articles: Porter and Millar, Spine 1988;13:1061-4 (score, 0.68), Eskola et al, Calcif Tissue Int 1992;50:400-3 (score, 0.88), Podichetty et al, Spine 2004;29:2343-9 (score, 0.88), and Tafazal et al, Eur Spine J 2007;16:207-12 (score, 0.92). Due to the great heterogenicity observed (sample sizes, selection criteria, doses, frequency, and duration of calcitonin, and outcome measurements), we were unable to perform a meta-analysis. Only one of these studies (Porter and Millar, Spine 1988;13:1061-4; score, 0.68) found favorable results for the use of calcitonin compared with placebo; of the 3 remaining trials none found significative evidence between drug therapy and placebo.
The present data suggest that calcitonin administration in the treatment for neurogenic claudication has no benefit in patients with lumbar spinal stenosis.
系统评价。
分析降钙素治疗腰椎管狭窄症患者神经源性跛行的有效性的证据水平。
腰椎管狭窄症最具致残性的特征之一是神经源性跛行。已经提出了多种药物治疗方法。降钙素在这些患者中的应用建议是基于自身对照临床试验（Streifler 等人，Neurol Neurosurg Psychiatry 1989；52:543-4），该试验仅纳入了 6 名患者。
我们在电子数据库（包括 Medline 和 Embase）上进行了检索，共检索到 10 篇原始文章，其中只有 4 篇符合随机对照试验标准。这些文章由 6 位之前经过培训的评审员独立和盲法评审，以提取数据并根据 Cochrane 手册（1996 年）的标准对其质量进行评分（最高得分为 1.00，最低得分为 0.33）。
4 篇文章的质量评分不同：Porter 和 Millar，Spine 1988；13:1061-4（评分 0.68），Eskola 等人，Calcif Tissue Int 1992；50:400-3（评分 0.88），Podichetty 等人，Spine 2004；29:2343-9（评分 0.88），和 Tafazal 等人，Eur Spine J 2007；16:207-12（评分 0.92）。由于观察到的异质性很大（样本量、选择标准、降钙素剂量、频率和持续时间以及结果测量），我们无法进行荟萃分析。只有一项研究（Porter 和 Millar，Spine 1988；13:1061-4；评分 0.68）发现与安慰剂相比，降钙素的使用对神经源性跛行有有利的结果；其余 3 项试验均未发现药物治疗与安慰剂之间有显著证据。
目前的数据表明，腰椎管狭窄症患者使用降钙素治疗神经源性跛行没有益处。
