Featured Research

from universities, journals, and other organizations

Steroid injection may lead to worse outcomes in patients with spinal stenosis

Date:
February 19, 2013
Source:
Wolters Kluwer Health: Lippincott Williams & Wilkins
Summary:
For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes—- whether or not the patient later undergoes surgery, according to a new study.

For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes -- whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine.

Related Articles


The study raises questions about the benefits of steroid injection -- a widely used treatment for the common problem of spinal stenosis in the lower (lumbar) spine. "There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically," according to the study by Dr Kris E. Radcliff of Thomas Jefferson University, Philadelphia, and colleagues.

Do Steroid Injections Help in Spinal Stenosis? The researchers analyzed data from the Spine Outcomes Research Trial (SPORT) -- one of the largest clinical trials of surgery for spinal disorders. In SPORT, patients meeting strict criteria for spinal stenosis (or other common spinal problems) were randomly assigned to surgery or nonsurgical treatment (such as physical therapy and medications). Patients with spinal stenosis have narrowing of the spinal canal, causing back pain, leg pain, and other symptoms.

The current analysis focused on the effects of ESI as part of treatment for spinal stenosis. Steroid injection is commonly recommended for patients whose symptoms don't improve with initial treatment.

Dr Radcliff and colleagues compared outcomes for 69 patients who underwent steroid injection during their first three months of enrollment in SPORT versus 207 patients who did not receive ESI. The two groups were similar in terms of most initial characteristics, although patients receiving steroid injections were more likely to prefer nonsurgical treatment: 62 versus 33 percent.

'Significantly Less Improvement' in Patients with ESI "Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT," the researchers write. Among patients who eventually had surgery, those who had ESI showed less improvement in physical functioning through four years' follow-up. For those treated nonsurgically, steroid injections were associated with less improvement in pain as well as functioning.

There was also evidence that surgery was more complicated in patients who had previously been treated with epidural steroids. On average, surgery took about one-half hour longer in patients who had received ESI, who also spent about one day longer in the hospital. Patients who received ESI were also more likely to "crossover" from their initially assigned treatment to the other treatment group. There was no evidence that receiving steroid injections helped patients to avoid surgery.

Lumbar spinal stenosis is a common problem in older adults. Epidural steroid injection is a common treatment for spinal stenosis, despite a lack of evidence showing its long-term benefits. The SPORT data provides an opportunity to examine how steroid injections affect long-term outcomes of spinal stenosis.

The new study has some important limitations, especially in that patients weren't randomly assigned to epidural steroid treatment. However, the results suggest that patients with spinal stenosis who receive ESI have less improvement at four years' follow-up, whether or not they subsequently undergo surgery.

Dr Radcliff and colleagues conclude, "Despite the common treatment practice of incorporating one or more ESI in the initial nonoperative management of patients with spinal stenosis, these results suggest that ESI is associated with worse outcome in the treatment of spinal stenosis," write. They believe the "most likely" reason for the worse outcomes after ESI is that the injection causes worsening of the spinal narrowing or result spinal nerve impingement, although other explanations are possible. The authors call for further research to clarify the "indications and results of this common procedure."


Story Source:

The above story is based on materials provided by Wolters Kluwer Health: Lippincott Williams & Wilkins. Note: Materials may be edited for content and length.


Journal Reference:

  1. Kris Radcliff, Christopher Kepler, Alan Hilibrand, Jeffrey Rihn, Wenyan Zhao, Jon Lurie, Tor Tosteson, Alexander Vaccaro, Todd Albert, James Weinstein. Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis. Spine, 2013; 38 (4): 279 DOI: 10.1097/BRS.0b013e31827ec51f

Cite This Page:

Wolters Kluwer Health: Lippincott Williams & Wilkins. "Steroid injection may lead to worse outcomes in patients with spinal stenosis." ScienceDaily. ScienceDaily, 19 February 2013. <www.sciencedaily.com/releases/2013/02/130219120939.htm>.
Wolters Kluwer Health: Lippincott Williams & Wilkins. (2013, February 19). Steroid injection may lead to worse outcomes in patients with spinal stenosis. ScienceDaily. Retrieved November 1, 2014 from www.sciencedaily.com/releases/2013/02/130219120939.htm
Wolters Kluwer Health: Lippincott Williams & Wilkins. "Steroid injection may lead to worse outcomes in patients with spinal stenosis." ScienceDaily. www.sciencedaily.com/releases/2013/02/130219120939.htm (accessed November 1, 2014).

Share This



More Health & Medicine News

Saturday, November 1, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Melafind: Spotting Melanoma Without a Biopsy

Melafind: Spotting Melanoma Without a Biopsy

Ivanhoe (Oct. 31, 2014) The MelaFind device is a pain-free way to check suspicious moles for melanoma, without the need for a biopsy. Video provided by Ivanhoe
Powered by NewsLook.com
Battling Multiple Myeloma

Battling Multiple Myeloma

Ivanhoe (Oct. 31, 2014) The answer isn’t always found in new drugs – repurposing an ‘old’ drug that could mean better multiple myeloma treatment, and hope. Video provided by Ivanhoe
Powered by NewsLook.com
Chronic Inflammation and Prostate Cancer

Chronic Inflammation and Prostate Cancer

Ivanhoe (Oct. 31, 2014) New information that is linking chronic inflammation in the prostate and prostate cancer, which may help doctors and patients prevent cancer in the future. Video provided by Ivanhoe
Powered by NewsLook.com
Sickle Cell: Stopping Kids’ Silent Strokes

Sickle Cell: Stopping Kids’ Silent Strokes

Ivanhoe (Oct. 31, 2014) Blood transfusions are proving crucial to young sickle cell patients by helping prevent strokes, even when there is no outward sign of brain injury. Video provided by Ivanhoe
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins