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

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

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