Study shows limited benefit of corticosteroids added to injections for spinal stenosis

Researchers found in a new study that injections of glucocorticoid combined with lidocaine, a local anesthetic, had about the same effect in patients with lumbar spinal stenosis as injections of lidocaine alone.

“Compared to injections with local anesthetic alone, injections with glucocorticoids provided these patients with minimal or no additional benefit.” lead author of the study, Janna L. Friedly, MD, an assistant professor of rehabilitation medicine at the University of Washington, in Seattle, stated in a press release.

Glucocorticoids, or corticosteroids, are commonly used to treat inflammation.

The double-blind study, just published in the New England Journal of Medicine, is the largest randomized clinical trial to look at the effectiveness of both treatments in this population. It included 400 patients with back and leg pain due to lumbar spinal stenosis who were randomized to receive either an epidural injections containing lidocaine or an epidural injection containing lidocaine plus a glucocorticoid.

The study was conducted at 16 U.S. medical centers.

Neither the patients in the study nor their doctors knew which treatment the patients received.

Patients who received glucocorticoid reported greater satisfaction with treatment, according to the press release, with 67% of those patients reporting being very satisfied or somewhat satisfied compared to 54% of those who received lidocaine alone reporting the same level of satisfaction with the treatment.

Improvements in leg pain and function were about the same in both groups, however the group that received corticosteroids improved more in depressive symptoms vs. the group that received lidocaine alone, according to the press release.

However, investigators reported more adverse events in the patients who received the injections that included glucocorticoid. Furthermore, based on the results, patients receiving the combination injections were more likely to have low morning serum cortisol levels at 3 weeks and 6 weeks after the injection, which the researchers noted suggest the corticosteroid was being absorbed in the general circulation and may have a broad systemic effects.

“If patients are considering an epidural injection, they should talk to their doctor about a lidocaine-only injection, given that corticosteroids do pose risks and this study found that they provided no significant added benefit at 6 weeks,” Friedly stated in the press release.

Disclosure: The study was funded by the U.S. Agency for Healthcare Research and Quality.