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Epidural Steroids Generally Are Ineffective for Lumbar Spinal Stenosis

July 2, 2014

Epidural Steroids Generally Are Ineffective for Lumbar Spinal Stenosis

  1. Allan S. Brett, MD

At 6 weeks, a steroid-lidocaine combination was no better than lidocaine alone.

  1. Allan S. Brett, MD

Despite widespread use of epidural steroid injections to treat patients with spinal stenosis, high-quality evidence to support their efficacy is nonexistent. In this multicenter, double-blind US study, researchers randomized 400 patients with symptomatic central lumbar spinal stenosis to receive an epidural injection of either lidocaine alone or lidocaine plus a glucocorticoid. All patients had moderate-to-severe pain (with pain in the buttock or leg greater than that in the back) and functional disability. About 40% of patients in each group requested and received a second injection at 3 weeks.

During 6 weeks of follow-up, mean scores on pain and disability scales (the primary outcomes) improved substantially in both the steroid and no-steroid groups. However, at 6 weeks, no significant differences were observed between groups for either of these primary outcomes. At 3 weeks, small, statistically significant differences favored the steroid group (a 0.6-point difference in pain on a 10-point scale, and a 1.8-point difference in disability on a 24-point scale), but these differences were deemed clinically unimportant. The proportions of patients with at least 30% improvement in pain or disability at 6 weeks were similar in the two groups. Interestingly, 10% of patients in the steroid group (but <1% of those in the no-steroid group) had morning serum cortisol levels <3 μg/dL at 3 weeks, suggesting a surprisingly long duration of adrenal suppression after a single epidural injection in some cases.

Comment

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 steroid injections in patients with sciatica: NEJM JW Gen Med Dec 13 2012.) 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.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

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Reader Comments (1)

Patric Foote Other, Other

Epidural steroids are not the permanent treatment for spinal stenosis. Lumbar Spinal Stenosis causes due to the narrowing of the individual's spinal canal. This happens when the growth of bone or other tissue reduces the size of the opening in the spinal bones. Visit http://goo.gl/vuHm1e for information regarding the treatments and surgery of various types of spinal stenosis.

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