The addition of a corticosteroid to epidural injections of an anesthetic does not enhance pain reduction in patients with lumbar spinal stenosis, a common cause of lower back and leg pain, according to a new study. The findings, published in the July 3 issue of New England Journal of Medicine and funded by AHRQ, studied patients six weeks after treatment and found those whose lidocaine anesthetic was supplemented with a corticosteroid experienced minimal to no additional benefit compared with patients who received injections of anesthetic alone.
Epidural injection of anesthetic with corticosteroid is a common treatment for lumbar spinal stenosis. It is estimated that more than 2.2 million lumbar epidural steroid injections are given each year to Medicare patients and that rates and associated costs of the procedure have increased nearly 300% over the last two decades, according to a news release.
The pain associated with lumbar stenosis can be excruciating, and patients are understandably looking for relief, AHRQ Director Richard Kronick, PhD, said in the release. This study raises questions about the benefits of combining corticosteroids with an anesthetic for patients with lumbar stenosis, and it will help patients and their physicians make better informed decisions about treatment options.
The study, the lumbar epidural steroid injections for spinal stenosis trial, was led by Janna L. Friedly, MD, assistant professor in the department of rehabilitation medicine at the University of Washington in Seattle. It was conducted at 16 hospitals in the U.S. and included 400 patients age 50 and older with evidence of lumbar stenosis and at least moderate pain. Half of the patients in the trial received epidural injections of anesthetic with corticosteroid, the other half received injections without corticosteroid.
The researchers found patients combining corticosteroids and lidocaine were more likely to report side effects and were more likely to absorb the corticosteroid into their bloodstream. Taken over time, corticosteroids can result in reduce bone density, increased risk of bone fracture and immunosuppression, according to the release.
This is the first large, multicenter randomized trial to look at epidural steroid injections for spinal stenosis, and we found that injection with corticosteroids and lidocaine provided these patients with minimal or no additional benefit over lidocaine injections, Friedly said in the release. If patients are considering an epidural injection, they should talk to their doctor about the benefits and risks of the options available.