Epidural Steroid Injections May Be Effective for Spinal Stenosis After All

Contrary to a study which concluded that epidural steroid injections were not helpful in the treatment of lumbar spinal stenosis, a letter in the journal Pain Medicine states that epidural steroid injections may provide good short term benefit, lasting from weeks to months.

The New England Journal of Medicine study “A Randomized Trial of Epidural Glucocorticoid Steroid Injections for Spinal Stenosis” was a large scale clinical trial evaluating the use of epidural steroids injections for spinal stenosis. Because of the study set-up and design, pain physicians questioned the validity of the results, with some agreeing with the main study outcome (injections were not helpful), while others reported consistent, short-term pain benefit of spinal stenosis symptoms.

Researchers from Boston University School of Medicine performed a retrospective case series, using multiple methods of injections and various steroid choices and found specific epidural steroid injections to be very effective. “The 2014 NEJM study on lumbar epidural steroids for spinal stenosis pain allowed for extreme variability in injection method and steroid type,” explained co-author Anthony K. Savino, MD, chief resident, BUSM’s department of neurology. “We feel that interlaminar injection, at the worst stenosis level, with long acting steroid is very helpful for spinal stenosis pain, and our case series supports this. Doing injections the way we propose will help with spinal stenosis pain, making walking easier/better and may help some patients avoid surgery.”

The authors suggest future large scale trials be designed since there are few non-surgical options for lumbar spinal stenosis.

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