Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial

Friedly, Janna; Comstock, Bryan A.; Turner, Judith A.; Heagerty, Patrick J.; Deyo, Richard A.; Bauer, Zoya; Avins, Andrew L.; Nedeljković, Srdjan S.; Nerenz, David R.; Shi, Xu; Annaswamy, Thiru M.; Standaert, Christopher J.; Smuck, Matthew; Kennedy, David J.; Akuthota, Venu; Sibell, David M.; Wasan, Ajay D.; Diehn, Felix E.; Suri, Pradeep; Rundell, Sean D.; Kessler, Larry G.; Chen, Allen S.; Jarvik, Jeffrey G.

doi:10.1016/j.apmr.2017.02.029

Cited by 31 publications

(25 citation statements)

References 18 publications

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“…Moreover, in patients in whom first injection didn't relieve pain within 6 weeks have no role in relieving pain with subsequent injections. 22 Vorobeychik Y et all found that the efficacy of epidural injections without using image intensifier lies for just 6 weeks which is much lower than our study. 23 Kamble PC did a study on Outcome of single level disc prolapse treated with transforaminal steroid versus epidural steroid versus caudal steroids and found that the pain was significantly low at 6 months interval in transforaminal steroid group as compared to others two.…”

Section: Discussioncontrasting

confidence: 70%

Spinal Stenosis

Ahmad¹,

Hussain²,

Ahmed³

et al. 2018

TPMJ

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Spinal stenosis causing lower back pain and radiculopathy and it is the most common cause of patient admission at Spine centre as compared to other spine pathologies. Most common complaint in the Spine outpatient department or hospital admissions Different modalities have been applied with time for its management. Among them Epidural steroid injection is also. Objectives: "To Compare three doses of epidural steroid injection with single dose of epidural steroid injection for Lumbar Radicular pain in spinal stenosis patients." Study Design: Prospective study.

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Section: Discussioncontrasting

confidence: 70%

Spinal Stenosis

Ahmad¹,

Hussain²,

Ahmed³

et al. 2018

TPMJ

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“…These results compare favorably with opioid-prevalence estimates associated with other interventions for LSS. For example, in a randomized trial of repeated epidural steroid injections for LSS, Friedly et al 30 reported baseline opioid-usage prevalence of 38% and 12-month prevalence of 41%, confirming and extending previous research demonstrating lack of long-term effectiveness for epidural steroid injections for treating chronic LSS symptoms. 31 , 32 …”

Section: Discussionsupporting

confidence: 60%

Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis

Nunley¹,

Deer²,

Benyamin³

et al. 2018

JPR

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BackgroundLumbar spinal stenosis (LSS) causes significant pain and functional impairment, and medical management has increasingly included the prescription of opioid-based analgesics. Interspinous process decompression (IPD) provides a minimally-invasive treatment option for LSS.MethodsThis study estimated the type, dosage, and duration of opioid medications through 5 years of follow-up after IPD with the Superion Indirect Decompression System (Vertiflex Inc., Carlsbad, CA USA). Data were obtained from the Superion-treatment arm of a randomized controlled noninferiority trial. The prevalence of subjects using opiates was determined at baseline through 60 months. Primary analysis included all 190 patients randomized to receive the Superion device. In a subgroup of 98 subjects, we determined opioid-medication prevalence among subjects with a history of opioid use.ResultsAt baseline, almost 50% (94 of 190) of subjects were using opioid medication. Thereafter, there was a sharp decrease in opioid-medication prevalence from 25.2% (41 of 163) at 12 months to 13.3% (20 of 150) at 24 months to 7.5% (8 of 107) at 60 months. Between baseline and 5 years, there was an 85% decrease in the proportion of subjects using opioids. A similar pattern was also observed among subjects with a history of opiates prior to entering the trial.ConclusionStand-alone IPD is associated with a marked decrease in the need for opioid medications to manage symptoms related to LSS. In light of the current opiate epidemic, such alternatives as IPD may provide effective pain relief in patients with LSS without the need for opioid therapy.

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“…A literature review revealed that several factors such as the injection approach (19), type of anesthetic (24,25), the number of injections (26), and type and dose of steroids could be different from study to study (27). Therefore, such differences should be kept in mind when comparing the results of different investigations.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Efficacy of Epidural Injection of Triamcinolone Through Translaminar Approach for the Treatment of Lumbar Canal Stenosis

et al. 2020

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Background: Epidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy. Objectives: In this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis. Methods: In a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI). Results: The study population included 32 (28.8%) males and 79 (71.2%) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r =-0.400, P < 0.001) and BMI (r =-0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r =-0.569, P < 0.001). Conclusions: Epidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis.

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Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial

Cited by 31 publications

References 18 publications

Spinal Stenosis

Spinal Stenosis

Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis

Short-Term Efficacy of Epidural Injection of Triamcinolone Through Translaminar Approach for the Treatment of Lumbar Canal Stenosis

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