Spinal Stensis-Clinical Trials- Part II of a II Part Article on Stenosis
(2/12/09)- The North American Spine Society (NASS), a medical society representing over 5,000 spine surgeons has adopted a new disclosure policy that will apply to doctors who present studies at future medical conferences. The policy requires that researchers disclose not just the existence of financial ties to medical-device companies, but the dollar amounts as well.
The society said its policy "is not a voluntary guideline, but a binding covenant which applies to all relationships engaged in by all participants in all" activities of the spine society. Violations of this policy could include suspension, expulsion or public censure to a member of the society. The sanction would not restrict a violator from continuing to practice medicine, but would be a blot on the record of a member who was censured.
(10/21/06)- Sadly, stenosis is a not uncommon issue in the
elderly. The figures indicate that 5 out of every 1000 person
over 50 has stenosis. We are listing some of the different
clinical trials that have already taken place or will be taking
place involving studies of spinal stenosis in the hope that this
information may be of some use to our viewers.
Department of Orthopaedics, University Hospitals of
Leicester, Leicestershire, UK, stafazal@hotmail.com.
a.. Tafazal SI,
b.. Ng L,
c.. Sell P.
This is a double blind randomized controlled trial to assess the
effectiveness of nasal salmon calcitonin in the treatment of
lumbar spinal stenosis. The trial compared the outcome of salmon
calcitonin nasal spray to placebo nasal spray in patients with
MRI confirmed lumbar spinal stenosis. Lumbar spinal stenosis is
one of the commonest conditions encountered by spine surgeons. It
more frequently affects elderly patients and lumbar decompression
has been used to treat the condition with variable success. Non
operative measures have been investigated, but their success
ranges from 15% to 43% in patients followed up for 1-5 years
(Simotas in Clin Orthop 1(384):153-161, 2001). Salmon calcitonin
injections have been investigated in previous trials and may have
a treatment effect. Nasal salmon calcitonin has become available
and if effective would have advantages over injections. Forty
patients with symptoms of neurogenic claudication and MRI proven
lumbar spinal stenosis were randomly assigned either nasal salmon
calcitonin or placebo nasal spray to use for 4 weeks. This was
followed by a 'washout' period of 6 weeks, and subsequent
treatment with 6 weeks of nasal salmon calcitonin. Standard spine
outcome measures including Oswestry disability index (ODI), low
back outcome score, visual analogue score and shuttle walking
test were administered at baseline, 4, 10 and 16 weeks. Twenty
patients received nasal salmon calcitonin and twenty patients
received placebo nasal spray. At 4 weeks post treatment there was
no statistically significant difference in the outcome measures
between the two groups. The change in ODI was a mean 1.3 points
for the calcitonin group and 0.6 points for the placebo group (P
= 0.51), the mean change in visual analogue score for leg pain
was 10 mm in the calcitonin group and 0 mm in the placebo group
(P = 0.51). There was no significant difference in walking
distance between the two groups, with a mean improvement in
walking distance of 21 m in the calcitonin group and 8 m in the
placebo group (P = 0.78). At the end of the trial the ODI had
improved by a mean of 3.7 points in the calcitonin group and 3.8
points in the placebo group (P = 0.44). This randomised placebo
controlled trial has not shown any treatment effect in patients
with lumbar spinal stenosis treated with nasal salmon calcitonin.
Effects of lumbar acupuncture stimulation on blood flow to
the sciatic nerve trunk--an exploratory study.
a.. Inoue M,
b.. Hojo T,
c.. Yano T,
d.. Katsumi Y.
Meiji University of Oriental Medicine, Kyoto, Japan. mo_inoue@muom.meiji-u.ac.jp
Acupunct Med. 2005 Dec;23(4):166-70. Links
INTRODUCTION: Acupuncture may have a role in the treatment of
intermittent claudication of the cauda equina due to lumbar
spinal canal stenosis. The aim of this study was to explore the
possible physiological mechanisms. METHODS: In a laboratory
experiment, manual acupuncture was performed at a point adjacent
to the sixth lumbar vertebra of 13 animals and its effect on
sciatic nerve blood flow was measured using a laser Doppler
flowmetry. Simultaneously, changes in blood pressure and cardiac
rate were observed. Each animal was stimulated four to eight
times, making a total of 58 experiments. RESULTS: Acupuncture
stimulation did not produce consistent changes in sciatic nerve
blood flow, with increased and decreased blood flow as well as no
change in blood flow observed. Among the 58 individual
experiments, sciatic nerve blood flow was increased in 33,
reduced in 12, and unchanged in 13. Approximately half of the
stimulations showed a correlation between blood flow and blood
pressure change. CONCLUSION: Our results indicate that lumbar
acupuncture stimulation can have an influence on sciatic nerve
blood flow. The effect is dependent not only on blood pressure
but also other factors, for example vasodilator and
vasoconstrictor nerve activity. This mechanism may contribute to
a clinical effect on intermittent claudication of the cauda
equina.
Please see our other article on Spinal
Stenosis- A Personal Chronicle - Part I
Spinal Stenosis- What has Worked or not
Worked for our Viewers- Part III
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"
Compiled by Harold Rubin
updated February 12, 2009
e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com