Calcitonin-Augmented Epidural Steroid Injection for Lumbar Canal Stenosis: A Randomized Controlled Study

ABSTRACT:

Background: Lumbar spinal canal stenosis (LSS) causes back and leg pain. Epidural steroid injection (ESI) provides shortterm relief in many patients. Calcitonin has analgesic properties and may augment ESI effects. Objective: To evaluate whether adding calcitonin to epidural steroid injection improves pain and function compared with steroid alone in symptomatic LSS. Methods: Prospective, randomized, double-blind trial. 73 patients/group (total n=146) with MRI-confirmed LSS received either methylprednisolone 40 mg + lidocaine 0.5% + saline (Group A) or methylprednisolone 40 mg + lidocaine 0.5% + calcitonin 50 IU (Group B). Two injections 1 week apart. Follow-up at 2 weeks, 1, 2, 3 (primary), 6 and 12 months. Primary outcome: change in VAS at 3 months. Results: At 3 months VAS decreased from 7.2±1.0 to 4.8±1.5 in Group A and to 3.1±1.4 in Group B (between-group p<0.001). ODI improved from 52±9% to 36±9% in Group A and to 28±8% in Group B (p=0.002). Walking distance increased from 150±60 m to 310±90 m (Group A) and to 430±110 m (Group B) at 3 months (p<0.001). Adverse events were mild: nausea (Group A 2/73, 2.7%; Group B 6/73, 8.2%). Conclusion: Calcitonin-augmented ESI provides superior pain relief and functional outcomes compared with steroid alone. Larger multicenter trials are recommended.

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