Are epidural steroid injections the best nonoperative option for patients with lumbar spinal stenosis?
A new study published in Spine examines data from the Spine Patient Outcomes Research Trial to determine how epidural steroid injections impact lumbar spinal stenosis patients. The data included 281 patients who completed baseline and six-month follow-up assessments. The average patient age was 75 years old. There were 229 patients who underwent surgery and 111 who received ESI in the 12 months before surgery.
Fifty-two patients relied on nonoperative treatment and 29 had prior ESI. The researchers found:
1. The improvement in Spinal Stenosis Measurement scores was greatest among patients who had surgery and prior ESI at 0.95; those who had surgery and no ESI reported 0.78 SSM score improvement.
2. The patients who had no surgery and prior ESI reported 0.28 SSM score improvement. The patients with no surgery and no prior ESI reported 0.29 score change.
3. The SSM-symptom score reduction was greater for surgery than nonoperative treatment patients by 0.41 when adjusting for confounding factors.
4. The impact of having ESI prior to the study was -0.08.
5. The study authors concluded, “The analysis of outcomes in the LSOS cohort provided no evidence that ESIs have a negative effect on the short-term outcomes of surgery or nonoperative treatment in patients with lumbar spinal stenosis.”