Do Epidural Steroids Improve Lumbar Spinal Stenosis (LSS) Pain?

A New England Journal of Medicine Study Raises Some Questions
 
In the search for better alternatives to manage LSS pain, some patients undergo excessive epidural steroid injections (ESIs) and obtain sustained relief. ESI use in Medicare patients increased almost 300% between 1994 and 2001. However, the results from a double-blind, randomized study published in The New England Journal of Medicine suggest little benefit of ESI in aging baby boomers. LSS is an abnormal narrowing of the center of the lumbar spine (called lumbar canal), which produces compression of the traveling leg nerves, resulting in standing discomfort and leg achiness, decreasing the patient’s ability to walk.

When are they effective?

In his published commentary at the same journal, Dr. Stephen Atlas, from the Practice-Based Research and Quality Improvement Network at the Massachusetts General Hospital, says that to treat patients with uncontrolled LSS pain, a brief curse of ESIs to reduce inflammation of the lumbar nerves may be appropriate before letting the patient undergo physical therapy.
 
“A few weeks of pain control would lead the patient to a healthier lifestyle, by increasing physical activity, reduce stress, use an anti-inflammatory diet may lead to longer pain relief and reduced healthcare costs,” says Dr. Gonzalez-Cota, Director of the Advantia Health Spine-Sports & Pain Center. “I don’t expect long-term benefits of ESIs without undergoing significant lifestyle changes.” If this approach does not result in pain control, a patient might be screened better for spine surgery since, as a general rule, we favor less invasive procedures in medical practice.
 
Empowering Patients
 
If patients were better informed about their spinal condition -- why it hurts when walking, expectations, risks from the ESI procedure -- fewer ESIs for LSS would be performed in the Medicare population. At Advantia Health, physicians follow the best practices in interventional spine medicine. By empowering patients and explaining their spine problems in simple language, a more informed decision takes place in partnership with their pain physician.

Reference
Friedly JL, et al. New England Journal of Medicine 2014.