Epidural Steroids Generally Are Ineffective for Lumbar Spinal Stenosis

Authors: Janna L. Friedly, M.D et al

A steroid-lidocaine combination is essentially no better than lidocaine alone for patients with symptomatic central lumbar spinal stenosis, according to a New England Journal of Medicine study.

U.S. researchers randomized 400 patients with symptomatic stenosis to receive an epidural injection of either lidocaine alone or lidocaine plus a glucocorticoid. All patients had moderate-to-severe pain and functional disability. About 40% of each group requested and received a second injection at 3 weeks.

During 6 weeks of follow-up, mean scores on pain and disability scales improved substantially in both the steroid and no-steroid groups. However, at 6 weeks, no significant differences were observed between the groups for either of these primary outcomes. At 3 weeks, small, statistically significant differences favored the steroid group, but these differences were deemed clinically unimportant.

At best, epidural steroids provide minimal transient benefit for patients with painful, disabling central lumbar spinal stenosis. According to a recent meta-analysis, the same is true for epidural steroids in patients with sciatica. An editorialist notes that some insurance companies require epidural injections as part of nonsurgical treatment before spinal stenosis surgery is approved; that policy obviously is misguided.