"Epidural Glucocorticoids for Spinal Stenosis".The New England Journal of Medicine. 2014. 371:11-21.
Links to original sources: Wiki Journal Post Full Journal Article
"Glucocorticoid vs Lidocaine Epidural Injections for Lumbar Spinal Stenosis".
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcomes 8.2 Secondary Outcomes 9 Funding 10 Further Reading
In patients with lumbar spinal stenosis and moderate-to-severe leg pain and disability, do epidural injections of glucocorticoids plus lidocaine offer significant improvements compared with injections of lidocaine alone?
In the treatment of lumbar spinal stenosis, epidural injections of glucocorticoids plus lidocaine provided minimal or no short-term benefit compared to injections of lidocaine alone.
Epidural glucocorticoid injections are popular for managing symptoms related to lumbar spinal stenosis, but evidence supporting their effectiveness and safety has been insufficient. The LESS trial provided controlled data, showing no significant differences in pain-related functional disability or pain intensity at 6 weeks between patients receiving glucocorticoids plus lidocaine and those receiving only lidocaine. Small benefits observed at 3 weeks did not persist at 6 weeks.
Current guidelines for the management of lumbar spinal stenosis are not available in this summary.
- Double-blind, multisite, randomized controlled trial - N=400 - Glucocorticoids plus lidocaine (n=200) - Lidocaine alone (n=200) - Setting: 16 sites in the USA - Enrollment: April 2011 to June 2013 - Analysis: Intention-to-treat - Primary evaluation: 6 weeks after randomization and first injection
- Adults ≥50 years with lumbar central spinal stenosis - Moderate-to-severe leg pain and disability
Inclusion Criteria - Evidence of central lumbar spinal stenosis on MRI or CT - Avg. pain rating >4 in the previous week for specific lower body regions - Score ≥7 on RMDQ
Exclusion Criteria - Non-central canal stenosis - Spondylolisthesis requiring surgery - History of lumbar surgery - Epidural glucocorticoid injections within the previous 6 months
Baseline Characteristics - Demographic, clinical, and disease history information - Comparable between groups except for duration of pain, which was shorter in the lidocaine-alone group
- Fluoroscopy-guided epidural injections - Glucocorticoid injectable solution or lidocaine only - One or two injections provided per patient protocol
Primary Outcomes - RMDQ score (0-24 scale; higher scores indicate greater disability) - Patient-reported leg pain intensity (0-10 scale)
- Brief Pain Inventory interference scale - Swiss Spinal Stenosis Questionnaire - Patient Health Questionnaire (PHQ-8) - Generalized Anxiety Disorder 7 scale (GAD-7) - EQ-5D questionnaire - Proportions with ≥30% or ≥50% improvement from baseline
Supported by a grant from the Agency for Healthcare Research and Quality.
Additional resources and publications related to lumbar spinal stenosis and epidural injections.