Ammendolia Carlo, Stuber Kent, Tomkins-Lane Christy, Schneider Michael, Rampersaud Y Raja, Furlan Andrea D, Kennedy Carol A
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,
Eur Spine J. 2014 Jun;23(6):1282-301. doi: 10.1007/s00586-014-3262-6. Epub 2014 Mar 15.
To investigate what interventions can improve walking ability in neurogenic claudication with lumbar spinal stenosis.
We searched CENTRAL, Medline, EMBASE, CINAHL and ICL databases up to June 2012. Only randomized controlled trials published in English and measuring walking ability were included. Data extraction, risk of bias assessment, and quality of the evidence evaluation were performed using methods of the Cochrane Back Review Group.
We accepted 18 studies with 1,220 participants. There is very low quality evidence that calcitonin is no better than placebo or paracetamol regardless of mode of administration. There is low quality evidence that prostaglandins, and very low quality evidence that gabapentin or methylcobalamin, improves walking distance. There is low and very low quality evidence that physical therapy was no better in improving walking ability compared to no treatment, oral diclofenac plus home exercises, or combined manual therapy and exercise. There is very low quality evidence that epidural injections improve walking distance up to 2 weeks compared to placebo. There is low- and very low-quality evidence that various direct decompression surgical techniques show similar significant improvements in walking ability. There is low quality evidence that direct decompression is no better than non-operative treatment in improving walking ability. There is very low quality evidence that indirect decompression improves walking ability compared to non-operative treatment.
Current evidence for surgical and non-surgical treatment to improve walking ability is of low and very low quality and thus prohibits recommendations to guide clinical practice.
探讨哪些干预措施可改善腰椎管狭窄症所致神经源性间歇性跛行的步行能力。
检索截至2012年6月的CENTRAL、Medline、EMBASE、CINAHL和ICL数据库。仅纳入以英文发表且测量步行能力的随机对照试验。采用Cochrane背部回顾组的方法进行数据提取、偏倚风险评估和证据质量评价。
我们纳入了18项研究，共1220名参与者。有极低质量的证据表明，无论给药方式如何，降钙素并不比安慰剂或对乙酰氨基酚效果更好。有低质量的证据表明前列腺素可改善步行距离，有极低质量的证据表明加巴喷丁或甲钴胺可改善步行距离。有低质量和极低质量的证据表明，与不治疗、口服双氯芬酸加家庭锻炼或手法治疗与锻炼相结合相比，物理治疗在改善步行能力方面并无优势。有极低质量的证据表明，与安慰剂相比，硬膜外注射在长达2周的时间内可改善步行距离。有低质量和极低质量的证据表明，各种直接减压手术技术在步行能力改善方面显示出相似的显著效果。有低质量的证据表明，在改善步行能力方面，直接减压并不比非手术治疗更好。有极低质量的证据表明，与非手术治疗相比，间接减压可改善步行能力。
目前关于改善步行能力的手术和非手术治疗的证据质量低或极低，因此无法给出指导临床实践的建议。
