Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysisThis analysis of the lumbar epidural steroid injections for spinal stenosis multicenter randomized controlled trial data identifies the degree of and risk factors epidural steroid injection for spinal stenosis cortisol suppression after epidural steroid injections in older adults with spinal stenosis. Four hundred patients aged 50 years and older with back or leg pain and central lumbar spinal stenosis completed baseline demographic and psychosocial measures. Morning serum cortisol levels were measured at baseline and 3 weeks after initial injection. The specific corticosteroid was chosen at the treating physician's discretion methylprednisolone, betamethasone, triamcinolone, or dexamethasone. The effect on 3-week cortisol changes did not differ by demographic or patient-level characteristics.
Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis
As surgery is a potentially risky option with uncertain benefit, many doctors turn to glucocorticoid injections for their patients, to decrease pain and increase mobility. But do glucocorticoid injections actually help? A recent review from the North American Spine Society highlighted the paucity of data, concluding that there is insufficient evidence to make a recommendation either for or against. With this background, Janna Friedly and colleagues set out to determine whether glucocorticoid injections actually benefit patients with spinal stenosis.
The study investigators enrolled patients with lumbar spinal stenosis, whose disease caused them moderate-to-severe leg pain and disability and who had been referred for steroid injections.
Patients were randomly assigned to either epidural glucocorticoid injection with lidocaine, or lidocaine injection alone. After six weeks, patients in both groups were asked to rate their average buttock, hip and leg pain in the previous week and to fill out a questionnaire that quantifies degree of pain and associated disability.
Both groups of patients reported improvement in their pain and physical function at three and six weeks, whether or not their injections included glucocorticoids. At six weeks, there were no significant differences in pain or function ratings between the two groups.
Of note, the patients randomly assigned to the glucocorticoid injections were more likely to have improvement in depressive symptoms. In an accompanying editorial discussing these results, orthopedic surgeon Gunnar Anderson notes the difficulties inherent in trials of treatments for spinal stenosis.
For one, spinal stenosis is a heterogeneous disease both in terms of cause — congenital versus degenerative — location, and extent. This entry was posted on Wednesday, July 2nd, at 5: You can follow any responses to this entry through the RSS 2. Both comments and pings are currently closed. Interesting work… Can you enlighten us please about those complications you mentioned? Since publishing my website in , although it was only aimed to inform, I have recieved emails and phone calls from hundreds of ex-Epidural Steroid Injection patients who have all developed Arachnoiditis ARC post injection s.
In some of these cases it was obviously difficult to put the horse before the cart in terms of whether it was the injection s or their original condition that caused the inflammation leading to ARC. However, in many others, there was no doubt about the culprit because their original back pain had not been diagnosed even after imaging studies. None of them described receiving any substantial benefit from the treatment s whilst the majority stated that their pain was greater post treatment than it had been prior to it.
Many of these describe a nightmarish scenario where the operator needed more than one attempt to place the injectate and on many occasions there were more than 3 attempts. Given the number of post dural puncture headaches one can only conclude that it was not in the epidural space. In the many years that I have spent researching this issue I have read paper after paper singing the praises of ESIs but none of them have been more than small scale studies without enough subjects to create a convincing result.
I also wondered why, if those responsible for using these procedures were so confident of their efficacy, the producers never formally applied for a licence? The answer to that question becomes clear when one reads the work of Nelson and Landau or, more recently, Nancy Epstein; they would not pass muster because they would prove to dangerous.
Recently New Zealand insisted that Pfizer included a warning on the package insert of their product that clearly stated it was not to be used in the Epidural or Intrathecal Spaces. Only two days ago I was informed that the company had requested the same change be included in their documentation in the UK. Once that is done the product will no longer be available for use by those who still support ESIs. I am a 81 yr, patient with spinal stenosis for the past 15 or so years. I have been treated for severe pain in the L1 thru L5 disks.
I have severe pain starting in the lower spine, that spreads through my buttocks, down my legs, through my ankles, and my feet. When I walk, it feels like I am walking on large rocks. My ankles have a lot of burning and pain as well.
I have had my right ankle replaced, my right knee,as well as my left shoulder due to degenerative arthritis. The last injection did not give me relief, so I went back in two weeks for another injection.
I firmly believe the injections do work for me and will continue this. Click to subscribe to The House Podcast on iTunes! July 2, at 8: July 3, at 3: July 3, at 6: July 4, at 3: