A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis

• Published in: The New England journal of medicine Vol. 371; no. 1; pp. 11 - 21
• Main Authors: Friedly, Janna L, Comstock, Bryan A, Turner, Judith A, Heagerty, Patrick J, Deyo, Richard A, Sullivan, Sean D, Bauer, Zoya, Bresnahan, Brian W, Avins, Andrew L, Nedeljkovic, Srdjan S, Nerenz, David R, Standaert, Christopher, Kessler, Larry, Akuthota, Venu, Annaswamy, Thiru, Chen, Allen, Diehn, Felix, Firtch, William, Gerges, Frederic J, Gilligan, Christopher, Goldberg, Harley, Kennedy, David J, Mandel, Shlomo, Tyburski, Mark, Sanders, William, Sibell, David, Smuck, Matthew, Wasan, Ajay, Won, Lawrence, Jarvik, Jeffrey G
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 03.07.2014
• Subjects: Aged; Anesthetics, Local - adverse effects; Anesthetics, Local - therapeutic use; Back; Back surgery; Biological and medical sciences; Clinical trials; Diseases of the osteoarticular system; Diseases of the spine; Double-Blind Method; Drug Therapy, Combination; Evidence-based medicine; Female; General aspects; Glucocorticoids; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Humans; Hydrocortisone - blood; Injection; Injections; Injections, Epidural; Leg; Lidocaine; Lidocaine - adverse effects; Lidocaine - therapeutic use; Lumbar Vertebrae; Male; Medical sciences; Middle Aged; Pain; Pain - drug therapy; Pain - etiology; Pain management; Pain Measurement; Patients; Spinal stenosis; Spinal Stenosis - complications; Spinal Stenosis - drug therapy; Steroids; Treatment Outcome; Extradural; Medicine; Spine disease; Lumbar spinal stenosis; Glucocorticoid; Diseases of the osteoarticular system
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1313265

In this trial in patients with lumbar central stenosis and moderate-to-severe leg pain and disability, epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit over epidural injection with lidocaine alone with respect to disability and pain. Lumbar spinal stenosis, a common cause of spine-related disability, is the leading reason for spinal surgery in older adults. 1 , 2 Degenerative changes resulting in narrowing of the spinal canal and nerve-root compression can cause back and leg pain, lower-extremity paresthesias, and weakness. 3 , 4 The treatment of symptomatic lumbar stenosis remains controversial. Symptoms of lumbar stenosis are commonly treated with epidural glucocorticoid injections. These injections typically contain a glucocorticoid and an anesthetic, which are thought to relieve pain by reducing nerve-root inflammation and ischemia. 1 An estimated 25% of all epidural glucocorticoid injections administered in the Medicare population and 74% of those . . .