Diario de columna vertebral

Epidural Corticosteroid Infiltrations for Lumbar Stenosis: A Prospective Study

Abstract

El Hajj Moussa M, Tawk C, Nohra G, Chamandi S and Lahoud JC

Introduction: Lumbar stenosis is a major cause of lower back pain and functional disability especially in elderly. Major symptoms are low back pain and radicular claudication. Medical therapeutic options include painkillers, NSAIDS, Steroids, antiepileptic drugs and epidural infiltrations. Surgery is indicated when medical treatment fails. The objective of our study is to evaluate the efficacy of lumbar epidural infiltrations of corticosteroids in LSS.

Materials and methods: This prospective study was conducted on 60 patients presenting to our institution from January 2013 to January 2014. Isolated LSS was suspected after physical examination and was confirmed by a lumbar MRI. All our patients were treated by NSAIDS and antiepileptic drugs (Gabapentin 800 mg daily) for 6 weeks. 7 patients had laminectomy during the year of follow-up and were excluded from the statistical analysis; 53 patients were followed-up for 1 year (88.3%). The treatment protocol by infiltrations consisted of three interlaminar epidural infiltrations under fluoroscopic guidance of 80 mg Methylprednisolone and 100 mg of Lidocaine administered at 2 weeks interval at the level of the stenosis. Gabapentin 800 mg per day (400 mg BID) was added for 1 month. Evaluation of clinical results was done using 4 scales: the Visual Numerical Scale (VNS), Roland5 Point Scale (R5PS), Walking distance (WD) and the patient satisfaction scale (PSS).

Results: The Mean VNS was significantly ameliorated from (7.27 (4-10) at D0 to, 3, 13 at 2 weeks follow-up and, 3.45 (1 to 6) at 1 year (p<0.0001). The Mean R5PS was also significantly ameliorated. At D0 the score was 4.08 (3 to 5), at D15 1.85 (0 to 3), at 1 y 1.83 (1 to 4) (p<0.0001). Mean WD was significantly increased from 1.85 at D0 to 3.34 at D15 and 3.34 at 1 (p<0.0001). The study of 50% amelioration of VNS, of R5PS and of WD were all significant with a p value <0.0001. The PSS showed very good and good results in 65% of the patients and average and bad results in 35%.

Discussion: Based on our results, epidural corticosteroid infiltrations are efficient in the treatment of LSS. Our study correlates with many results in the literature although few studies were conducted exclusively on LSS. We attributed the efficacy of steroids in LSS to their probable ability to block the nociceptive pathways and to their effect on prostaglandins.

Conclusion: As an alternative for medical treatment, epidural infiltrations of corticosteroids could be a promising option before indicating surgery in LSS, or if surgery is contraindicated.