Contradicting a previous study published in the New England Journal Medicine (NEJM), a new study has found that patients with spinal stenosis experienced a good short term benefit after receiving epidural steroid injections (ESI). The findings were published in a letter in the journal Pain Medicine.
Study: Spinal Stenosis Patients DO Respond Well to Epidural Steroids
1 min read Premium comments
Secondary
According to the September 4, 2015 news release, researchers from Boston University School of Medicine (BUSM) performed a retrospective case series, using multiple methods of injections and various steroid choices and found specific epidural steroid injections to be very effective.
“The 2014 NEJM study on lumbar epidural steroids for spinal stenosis pain allowed for extreme variability in injection method and steroid type, ” explained co-author Anthony K. Savino, M.D., chief resident, BUSM’s department of neurology. “We feel that interlaminar (between vertebrae) injection, at the worst stenosis level, with long acting steroid is very helpful for spinal stenosis pain, and our case series supports this. Doing injections the way we propose will help with spinal stenosis pain, making walking easier/better and may help some patients avoid surgery.”
Senior author Michael Perloff, M.D., Ph.D., told OTW, “Senior pain physicians will tell you (anecdotally) that spinal stenosis epidurals need to be at the worst level and interlaminar (as tranforaminal doesn’t ‘get in’) to have benefit. When we set up the clinical search engine, eight patients met criteria. I felt blinded, as I did not remember the individuals. Surprisingly, when reading the specific post procedure clinic notes most got very good benefit for months and longer.”
“A large scale study (hundreds of patients) would be most useful. Getting physicians to agree on standardization of technique will prove difficult, an obstacle for a multi-center trial. We plan a smaller blinded clinical trial, at one center, with 20-40 patients to hopefully pave the way for a multicenter trial with standardized epidural technique and steroid use for spinal stenosis.”
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.