"Epidural Glucocorticoids for Spinal Stenosis".The New England Journal of Medicine. 2014. 371:11-21.PubMed•Full text•PDF

"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

Clinical Question

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?

Bottom Line

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.

Major Points

Guidelines

Current guidelines for the management of lumbar spinal stenosis are not available in this summary.

Design

- 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

Population

- 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

Interventions

- Fluoroscopy-guided epidural injections
- Glucocorticoid injectable solution or lidocaine only
- One or two injections provided per patient protocol

Outcomes

Primary Outcomes
- RMDQ score (0-24 scale; higher scores indicate greater disability)
- Patient-reported leg pain intensity (0-10 scale)

Secondary Outcomes
- 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

Funding

Supported by a grant from the Agency for Healthcare Research and Quality.

Further Reading

Additional resources and publications related to lumbar spinal stenosis and epidural injections.