Epidural Steroids Generally Are Ineffective for Lumbar Spinal Stenosis — Physician’s First Watch

Medical News |
July 3, 2014

Epidural Steroids Generally Are Ineffective for Lumbar Spinal Stenosis

By Allan S. Brett, MD

Edited by Susan Sadoughi, MD, and Lorenzo Di Francesco, MD, FACP, FHM

A steroid-lidocaine combination is essentially no better than lidocaine alone for patients with symptomatic central lumbar spinal stenosis, according to a New England Journal of Medicine study.

U.S. researchers randomized 400 patients with symptomatic stenosis to receive an epidural injection of either lidocaine alone or lidocaine plus a glucocorticoid. All patients had moderate-to-severe pain and functional disability. About 40% of each group requested and received a second injection at 3 weeks.

During 6 weeks of follow-up, mean scores on pain and disability scales improved substantially in both the steroid and no-steroid groups. However, at 6 weeks, no significant differences were observed between the groups for either of these primary outcomes. At 3 weeks, small, statistically significant differences favored the steroid group, but these differences were deemed clinically unimportant.

At best, epidural steroids provide minimal transient benefit for patients with painful, disabling central lumbar spinal stenosis. According to a recent meta-analysis, the same is true for epidural steroids in patients with sciatica. An editorialist notes that some insurance companies require epidural injections as part of nonsurgical treatment before spinal stenosis surgery is approved; that policy obviously is misguided.

Dr. Brett is Editor-in-Chief of NEJM Journal Watch General Medicine, from which this story is adapted.

Reader Comments (3)

PAUL APRIL Physician, Rheumatology, retired

No surprise to none orthopedists,neurosurgeons or pain specialists.

Kenneth Zahl MD Physician, Anesthesiology, NE Penna

Flawed study as there was no non treatment control group, both groups improved; and anecdotal evidence has shown that even epidural saline can improve pain from lumbar HNP

Marion R. McMillan MD Physician, Anesthesiology, Spine ASC

That comment along with epidural steroids and 90% of what so-called pain "doctors" do needs to be placed in the anecdotal trashcan of bogus medical interventions. These crooks and their potions are a blight on the record of an otherwise honorable profession. Thankfully, the charade is exposed and judgment is on the way.

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