Improvement in Neurogenic Pain with Epidural Injections Following Interspinous Spacer Implantation in Patients with Lumbar Stenosis: A Case Series

Abstract

Background: Lumbar spinal stenosis with neurogenic claudication can be a debilitating condition, affecting quality of life. Interspinous spacer implantation is a minimally invasive procedure for treatment of lumbar spinal stenosis with neurogenic claudication and associated symptoms by minimizing spinal extension and therefore neural compression. Case Presentation: This case series presents 4 cases of patients with multilevel stenosis, most radiographically severe in the lumbar region, all who received interspinous spacers at L3-4 and L4-5 after minimal improvement in symptoms with conservative management including epidural injections. In all 4 cases, patients reported improved standing and gait but limited improvement in pain and overall function after interspinous spacer implantation. Each patient underwent repeat epidural injections at or below the level of the interspinous spacer with significant improvement in pain for up to 6 months. Conclusion: Our conclusion is that either postspacer epidural injections helped reduce inflammation associated with the implantation procedure, or the spacer maintained an open space to allow the injectate to permeate areas with the most stenosis and help reduce inflammation and therefore pain. Key words: Epidural injection, interspinous process decompression, interspinous spacer, interspinous spacer implant, low back pain, lumbar spinal stenosis, neurogenic claudication, spinal stenosis