Steroid injection may lead to worse outcomes in patients with spinal stenosis

February 19, 2013, Wolters Kluwer Health

For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes—whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine.

The study raises questions about the benefits of steroid injection—a widely used treatment for the common problem of spinal stenosis in the lower (lumbar) spine. "There was no improvement in outcome with ESI whether 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 and medications). Patients with spinal stenosis have narrowing of the , causing back 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 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 ," 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."

Explore further: Researchers find epidural steroid injections do not benefit spine patients

Related Stories

Researchers find epidural steroid injections do not benefit spine patients

February 7, 2012
Researchers at the Rothman Institute at Jefferson examined data on patients being treated for lumbar stenosis and the degenerative spine condition spondylolisthesis and found that patients who received epidural steroid injections ...

Steroid injection linked with significant bone loss in postmenopausal women treated for back pain

December 1, 2012
Postmenopausal women suffered significant bone density loss in their hip after they were treated with an epidural steroid injection for back pain relief, according to a Henry Ford Hospital study

Surgeon experience affects complication rate of spinal stenosis surgery

June 7, 2012
For patients undergoing surgery for spinal stenosis, the risk of complications is higher when the surgeon performs very few such procedures—less than four per year, suggests a study in the June issue of Neurosurgery, ...

Recommended for you

Building better tiny kidneys to test drugs and help people avoid dialysis

February 16, 2018
A free online kidney atlas built by USC researchers empowers stem cell scientists everywhere to generate more human-like tiny kidneys for testing new drugs and creating renal replacement therapies.

Expanding Hepatitis C testing to all adults is cost-effective and improves outcomes

February 16, 2018
According to a new study, screening all adults for hepatitis C (HCV) is a cost-effective way to improve clinical outcomes of HCV and identify more infected people compared to current recommendations. Using a simulation model, ...

Study suggests expanded range for emerging tick-borne disease

February 16, 2018
Human cases of Borrelia miyamotoi, a tick-borne infection with some similarities to Lyme disease, were discovered in the eastern United States less than a decade ago. Now new research led by the Yale School of Public Health ...

Flu shot only 36 percent effective, making bad year worse (Update)

February 15, 2018
The flu vaccine is doing a poor job protecting older Americans and others against the bug that's causing most illnesses.

IFN-mediated immunity to influenza A virus infection influenced by RIPK3 protein

February 15, 2018
Each year, influenza kills half a million people globally with the elderly and very young most often the victims. In fact, the Centers for Disease Control and Prevention reported 37 children have died in the United States ...

A new class of drug to treat herpes simplex virus-1 infection

February 14, 2018
For patients with the herpes simplex-1 virus (HSV-1), there are just a handful of drugs available to treat the painful condition that can affect the eyes, mouth and genitals.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.