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Kim, Min, Yoon, Seo, Kim, and Jo: Efficacy of Epidural Steroid Injection in Lumbar Spinal Stenosis
Original Article

Journal of Korean Spine Surg 2005;12(4):310-315.

Published online: 12 February 2005

DOI: https://doi.org/10.4184/jkss.2005.12.4.310

Efficacy of Epidural Steroid Injection in Lumbar Spinal Stenosis

Hee Seon Kim, M.D., Hak Jin Min, M.D., Ui Seoung Yoon, M.D., Jae Sung Seo, M.D., Yoon Jong Kim, M.D., Seung Mok Jo, M.D.

Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea

Address reprint requests to Hak Jin Min, M.D. Department of Orthopaedic Surgery, Seoul Medical Center 171-1 Samsung-dong, Kangnam-gu, Seoul 135-740, Korea Tel: 82-2-3430-0621, Fax: 82-2-539-1262, E-mail: spinemin@dreamwiz.com

Copyright © 2005 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

This is a retrospective study.

Objective

We wanted to evaluate the efficacy of epidural steroid injection (ESI) for treating lumbar spinal stenosis (LSS)

Summary of Literature Review

Treatment for lumbar spinal stenosis has generally consisted of some form of conservative treatment or surgery. Surgery may be contraindicated in many stenotic patients because of their significant comorbidities. Therefore, conservative management is necessary for those who cannot or do not want to undergo surgery.

Materials and Methods

From January 2002 to June 2003, we retrospectively analyzed 128 patients, 55 years or older, who received ESI (s). The average age of the men and women was 47 and 81, respectively. Their mean age was 76 (age range:55~84). The injection materials were 2 ml methylprodnisolone acetate (40 mg/cc) in combination with 3 cc normal saline and 3 cc lidocaine. The follow up period was 12 months to 30 months. We measured the outcomes by the duration and amount of pain relief, the change in functional status and the rate of performing surgery; patient satisfaction was assessed by a 5- item questionnaire.

Result

Of the 128 participants, 31% reported more than 2 months of pain relief, 41% reported less than 2 months of pain relief and 27% reported no relief from the injection (s). Sixteen percent subsequently had surgery. Sixty- nine percent reported improvement in their functional abilities. Seventy- two percent were at least somewhat satisfied with ESI as a form of treatment.

Conclusion

ESI is a reasonable treatment for LSS as it provided one third of our patient population with sustained relief and more than half with sustained improvement in function.

Keywords: Spine, Spinal stenosis, Epidural steroid injection.

REFERENCES

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Table 1.
Outcome Assessment Instruments
Questionnaire for Nonsugery Participants
1. From the epidural, did you have: No relief, relief > 2 months, relief < 2months
2. How would you rate the overall pain relief that you have had from the epidurals?
A. Initially: Full, partial, none
B. Currently: Full, partial, none
3. Do you think the epidurals have improved your ability to perform your daily activities?
Yes, partially, no
4. What was your overall satisfaction with the epidurals?
Very satisfied, somewhat satisfied, very unsatisfied
5. Would you repeat the epidurals if necessary?
Yes, no
Questionnaire for Back Surgery Participants
1. Question 1 and 5 as above
2. How would you rate your pain relief from surgery?
Full, partial, none
3. Has surgery improved your ability to perform your daily activities?
Yes, partially, no
4. What was your overall satisfaction with surgery?
Very satisfied, somewhat satisfied, very unsatisfied
Table 2.
Univariate Analysis for Qeustion 1 (2>m/<2 m/None) (N=128)
Variable P valure Odds ratio
Surgery∗ <.001 -
Gender† 0.20 1.45 (men vs women)
Multilevel† 0.97 1.04 (none vs some)
Diabetes† 0.42 1.38 (none vs some)
Smoking† 0.11 2.57 (some vs none)
No. of injection(1,2,>2)† † .008  
Age† 0.91 1.03 (>72y vs <72)
Spodylolisthesis† † .093  

∗ Mantel-Haenszel test;

† ordinal logistic regression;

† multinomial regression

Table 3.
Multivariate Analysis∗ for Question 1 (>2 m/<2 m/None) (N=128)
Variable P value
No. of injection .008
Age 0.70
Gender 0.25
Multilevel 0.84
Diabetes 0.17
Smoking 0.64
Spondylolisthesis .073

∗ Multinomial regression

Table 4.
Univariate Analysis for Qeustion 2A (1=full/2=partial/3=none): Nonsurgery Patients Only (n=107)
Variable P value Odds Ratio
No. of injection† .008 2.11 (men vs women)
Age∗ 0.86 1.18 (some vs none)
Gender∗ 0.47  
Multilevel∗ 0.63 1.17 (some vs none)
Diabetes† .069  
Smoking∗ 0.83 1.07 (<72y vs >72y)
Spondylolisthesis 0.87 1.13 (some vs none)

∗ Ordinal logistic regression;

† multinomial regression

Table 5.
Multivariate Analysis∗ for Question 2A(1=Full/2=partial/3=none) (n=107)
Variable P value
No. of injection .003
Age 0.85
Gender .076
Multilevel 0.77
Diabetes 0.14
Smoking 0.86
Spondylolisthesis 0.97

∗ Multinomial regression

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