Clinical Survey: Patterns of Utilization of Lumbar Epidural Steroid Injections by a Cohort of Spinal Surgeons

LeBude, Bryan; Wang, Dajie; Maltenfort, Mitchel; Anderson, D. Greg; Vaccaro, Alexander R.; Ratliff, John K.

doi:10.1016/j.pmrj.2008.11.013

Cited by 5 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Epidural steroid injections (ESI) represent a common option for nonsurgical treatment of LSS and can be delivered either via an interlaminar or transforaminal route. A survey of spinal surgeons indicates that the majority (69%) consider ESI to represent the first line of invasive treatment for LSS after a course of conservative management has failed to provide significant relief 1 . This high rate of ESI use continues despite conflicting reports as to the efficacy of this treatment in randomized, controlled trials 2-4 and a recent report casting doubt on the cost-effectiveness of ESI 5 .…”

Section: Introductionmentioning

confidence: 99%

Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis

Radcliff

Kepler

Hilibrand

et al. 2013

Spine

View full text Add to dashboard Cite

Summary of Background Data Lumbar spinal stenosis is a common incidental finding among adults over the age of 60, The use of ESI in these patients is common, although there is little evidence in the literature to demonstrate the long-term benefit of ESI in the treatment of lumbar stenosis. Objective The hypothesis of this study was that patients who received epidural steroid injections (ESI) during initial treatment as part of the Spine Patient Outcomes Research Trial (SPORT) would have improved clinical outcomes and a lower rate of crossover to surgery compared to patients who did not receive ESI. Methods Patients with lumbar spinal stenosis who received epidural steroid injections within the first three months of enrollment in SPORT (ESI) were compared to patients who did not receive epidural injections during the first three months of the study (No ESI). Results There were 69 ESI patients and 207 No-ESI patients. There were no significant differences in demographic factors, baseline clinical outcome scores, or operative details although there was a significant increase in baseline preference for nonsurgical treatment among ESI patients (62% vs. 33%, p <0.001). There was an average 26 minute increase in operative time and an increased length of stay by 0.9 days among the ESI patients who ultimately underwent surgical treatment. Averaged over four years, there was significantly less improvement in SF36 PF among surgically treated ESI patients (ESI 14.8 vs. No-ESI 22.5, p=0.025). In addition, there was also significantly less improvement among the nonsurgically treated patients in SF36 BP (ESI 7.3 vs. No-ESI 16.7, p=0.007) and SF36 PF (ESI 5.5 vs. No-ESI 15.2, p=0.009). Of the patients assigned to surgical treatment, there was a significantly increased crossover to nonsurgical treatment among patients who received an ESI (ESI 33% vs. No ESI 11%, p=0.012). Of the patients assigned to non-operative treatment, there was a significantly increased crossover to surgical treatment in the ESI patients (ESI 58% vs. No ESI 32%, p=0.003). Conclusion Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT. Furthermore, ESI were associated with longer duration of surgery and longer hospital stay. There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically.

show abstract

Section: Introductionmentioning

confidence: 99%

Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis

Radcliff

Kepler

Hilibrand

et al. 2013

Spine

View full text Add to dashboard Cite

show abstract

“…Titles and abstracts were compiled for initial screening, and full texts were retrieved and read, yielding 55 relevant articles. Of the 55 articles, 19 provided partial or full questionnaire contents [ 12 – 29 ], all of which are referred to as model questionnaires in our study. The remaining 36 papers that did not provide questionnaire contents were further reviewed for additional information appropriate for inclusion (YSS).…”

Section: Methodsmentioning

confidence: 99%

A survey among Korea Medicine doctors (KMDs) in Korea on patterns of integrative Korean Medicine practice for lumbar intervertebral disc displacement: Preliminary research for clinical practice guidelines

Shin

Lee

et al. 2015

BMC Complement Altern Med

View full text Add to dashboard Cite

BackgroundPatients seek Korean Medicine (KM) treatment for a broad range of complaints in Korea, but predominantly for musculoskeletal disorders. We investigated lumbar Intervertebral Disc Displacement (IDD) practice patterns of Korean Medicine doctors (KMDs) within a hospital/clinic network specializing in KM treatment of spinal disorders through survey of diagnosis and treatment methods.MethodsQuestionnaires on clinical practice patterns of KM treatment for lumbar IDD were distributed to 149 KMDs on January 25th, 2015. The questionnaire included items on sociodemographic characteristics, clinical practice patterns, and preferred method of lumbar IDD diagnosis and treatment. KMDs were asked to grade each treatment method for absolute and relative importance in treatment and prognosis, and safety.ResultsA total 79.19 % KMDs (n = 118/149) completed the survey, and results showed that integrative care mainly consisting of acupuncture, herbal medicine, Chuna manipulation, and pharmacopuncture was administered to IDD patients. The participant KMDs largely relied on radiological findings (MRI and X-ray) for diagnosis. ‘Eight principle pattern identification’, ‘Qi and Blood syndrome differentiation’ and ‘Meridian system syndrome differentiation’ theories were generally used for KM syndrome differentiation. The most frequently prescribed herbal medication was Chungpa-jun, and most commonly used Chuna technique was ‘sidelying lumbar extension displacement treatment’. IDD patients received 1.9 ± 0.3 treatment sessions/week, and KMDs estimated that an average 9.6 ± 3.5 weeks were needed for 80 % pain relief.ConclusionsThis is the first study to investigate expert opinion on KM treatment of IDD. Further randomized controlled trials and clinical guidelines based on clinical practice patterns of KM are called for.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-015-0956-1) contains supplementary material, which is available to authorized users.

show abstract

“…In a survey, epidural steroid injections were considered to be the first line invasive treatments after conservative management failed to provide significant relief to pain in patients and were referred for surgical interventions 5 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Caudal Epidural Steroid Injection with Interlaminar Lumbar Inj. Epidural in Spinal Stenosis

Akram¹,

Farooqi²,

Jabbar³

2021

PJMHS

View full text Add to dashboard Cite

Background: Lumbar spinal stenosis is a condition caused by narrowing of spinal canal. Steroid injection either lumbar or caudal can improve the functional outcome and low back pain. Aim: To compare the outcome of caudal epidural steroid injection with lumbar epidural steroid injection in treating spinal stenosis in patients suffering from sciatica. Methods: In this prospective study 338 patients having low backache due to spinal stenosis with sciatica were included from June 2013 to December 2014. Patients were randomly divided into two groups. Group I and II. Patients in Group I (160 patients) received caudal epidural steroid injections while the patients in Group II (178 patients) received lumbar epidural steroid injections. Visual analog scale (VAS) and Oswestry Disability Index (ODI) was used to assess outcome of the Caudal and Lumbar steroid injections and was measured at 2 weeks, at 3months, and improvement was declared if VAS decrease ≥50% of baseline and Oswestry disability index decrease ≥40% at 3 months. Results: In group I, there were 70(43.75%) males and 90(56.25%) females, while in group II there were 98(55.1%) males and 80(44.9%) females. The mean age of the patients in group I was 46.46±10.37 (18-75 years) years and was 43.77±15.27 years (18-75 years) in group II (P=0.0619). The change in pain score (>50%) was observed in 159 (89.33%) in group II compared with 121 (75%) in group I (P=0.0008). Conclusion: Lumbar epidural of steroids injections are more effective then caudal epidural injection of steroids in treating spinal stenosis. MeSH words: Caudal epidural, Lumbar epidural, Sciatica

show abstract

Clinical Survey: Patterns of Utilization of Lumbar Epidural Steroid Injections by a Cohort of Spinal Surgeons

Abstract: No consensus was found as to timing, frequency, and duration of ESI treatment in lumbar HNP and DDD patients in a survey of practicing spine surgeons. These results illustrate one example of lack of consensus in conservative treatment protocols.

Cited by 5 publications

References 24 publications

Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis

Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis

A survey among Korea Medicine doctors (KMDs) in Korea on patterns of integrative Korean Medicine practice for lumbar intervertebral disc displacement: Preliminary research for clinical practice guidelines

Comparison of Caudal Epidural Steroid Injection with Interlaminar Lumbar Inj. Epidural in Spinal Stenosis

Contact Info

Product

Resources

About