Navigation Links
Steroid injection may lead to worse outcomes in patients with spinal stenosis
Date:2/19/2013

Philadelphia, Pa. (February 19, 2013) - For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomeswhether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study raises questions about the benefits of steroid injectiona widely used treatment for the common problem of spinal stenosis in the lower (lumbar) spine. "There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically," according to the study by Dr Kris E. Radcliff of Thomas Jefferson University, Philadelphia, and colleagues.

Do Steroid Injections Help in Spinal Stenosis?

The researchers analyzed data from the Spine Outcomes Research Trial (SPORT)one of the largest clinical trials of surgery for spinal disorders. In SPORT, patients meeting strict criteria for spinal stenosis (or other common spinal problems) were randomly assigned to surgery or nonsurgical treatment (such as physical therapy and medications). Patients with spinal stenosis have narrowing of the spinal canal, causing back pain, leg pain, and other symptoms.

The current analysis focused on the effects of ESI as part of treatment for spinal stenosis. Steroid injection is commonly recommended for patients whose symptoms don't improve with initial treatment.

Dr Radcliff and colleagues compared outcomes for 69 patients who underwent steroid injection during their first three months of enrollment in SPORT versus 207 patients who did not receive ESI. The two groups were similar in terms of most initial characteristics, although patients receiving steroid injections were more likely to prefer nonsurgical treatment: 62 versus 33 percent.

'Significantly Less Improvement' in Patients with ESI

"Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT," the researchers write. Among patients who eventually had surgery, those who had ESI showed less improvement in physical functioning through four years' follow-up. For those treated nonsurgically, steroid injections were associated with less improvement in pain as well as functioning.

There was also evidence that surgery was more complicated in patients who had previously been treated with epidural steroids. On average, surgery took about one-half hour longer in patients who had received ESI, who also spent about one day longer in the hospital. Patients who received ESI were also more likely to "crossover" from their initially assigned treatment to the other treatment group. There was no evidence that receiving steroid injections helped patients to avoid surgery.

Lumbar spinal stenosis is a common problem in older adults. Epidural steroid injection is a common treatment for spinal stenosis, despite a lack of evidence showing its long-term benefits. The SPORT data provides an opportunity to examine how steroid injections affect long-term outcomes of spinal stenosis.

The new study has some important limitations, especially in that patients weren't randomly assigned to epidural steroid treatment. However, the results suggest that patients with spinal stenosis who receive ESI have less improvement at four years' follow-up, whether or not they subsequently undergo surgery.

Dr Radcliff and colleagues conclude, "Despite the common treatment practice of incorporating one or more ESI in the initial nonoperative management of patients with spinal stenosis, these results suggest that ESI is associated with worse outcome in the treatment of spinal stenosis," write. They believe the "most likely" reason for the worse outcomes after ESI is that the injection causes worsening of the spinal narrowing or result spinal nerve impingement, although other explanations are possible. The authors call for further research to clarify the "indications and results of this common procedure."


'/>"/>

Contact: Connie Hughes
connie.hughes@wolterskluwer.com
646-674-6348
Wolters Kluwer Health
Source:Eurekalert

Related medicine news :

1. Steroid Shots for Tennis Elbow Miss the Mark: Study
2. Do non-steroidal anti-inflammatory drugs cause kidney failure in children?
3. Botox beats steroids for painful foot condition, plantar fasciitis
4. University of Cincinnati leads first trial on steroid and CNI withdrawal post-transplant
5. Meningitis/Steroid Toll Now 34 Dead
6. Congress to Open Hearings Into Steroid/Meningitis Outbreak
7. Steroid Shots for Sciatica: Benefits Only Brief, Analysis Finds
8. Expensive arthritis treatment no better than steroid therapy
9. Report Details Start of Steroid Meningitis Outbreak
10. Steroid-Meningitis Toll Now 30 Dead, 419 Sickened, CDC Says
11. Greenish-Black Contaminant in Vials of Steroid Behind Meningitis Outbreak: FDA
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/27/2016)... ... June 27, 2016 , ... "FCPX editors can now reveal their media with ... X," said Christina Austin - CEO of Pixel Film Studios. , ProSlice Color ... users can now reveal the media of their split screens with growing colorful ...
(Date:6/26/2016)... PLAINSBORO, N.J. (PRWEB) , ... June 27, 2016 , ... ... same sources, yet in many ways they remain in the eye of the beholder, ... Oncology (EBO), a publication of The American Journal of Managed Care. For the full ...
(Date:6/26/2016)... Orion, Clarkston, Michigan (PRWEB) , ... June 26, ... ... with respect to fertility once they have been diagnosed with endometriosis. These women ... intercourse but they also require a comprehensive approach that can help for preservation ...
(Date:6/25/2016)... ... ... First Choice Emergency Room , the largest network of independent freestanding emergency ... its new Mesquite-Samuell Farm facility. , “We are pleased to announce Dr. Ogunleye ... M. Muzzarelli, Executive Medical Director of First Choice Emergency Room. , Dr. Ogunleye ...
(Date:6/24/2016)... Angeles, CA (PRWEB) , ... June 24, 2016 , ... ... surgery procedures that most people are unfamiliar with. The article goes on to state ... procedures, but also many of these less common operations such as calf and cheek ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... June 23, 2016 Research and ... Procedure Volumes: Global Analysis (United States, China, Japan, Brazil, ... report to their offering. ... for healthcare business planners, provides surgical procedure volume data ... trends with an in-depth analysis of growth drivers and ...
(Date:6/23/2016)... NEW YORK , June 23, 2016 ... rough waters, but it continues to present great opportunities ... featured companies for today: Intrexon Corp. (NYSE: ... ), Arena Pharmaceuticals Inc. (NASDAQ: ARNA ), ... Learn more about these stocks and receive your complimentary ...
(Date:6/23/2016)... Leading BioSciences Inc., a clinical-stage biopharmaceutical ... from a breakdown of the mucosal barrier, today ... as chief executive officer. Mr. Doyle, a ... and board of directors, previously served as chief ... provide continued leadership and strategic direction to the ...
Breaking Medicine Technology: