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 short term 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.