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  • Epidural Corticosteroids Infiltrations For Lumbar Stenosis: A Prospective Study

    Final Number:
    311

    Authors:
    Majd G El Hajj Moussa MD; Charbel Tawk MD; Georges Nohra; Souhail Chamandi; Jean-Claude Lahoud MD, PhD

    Study Design:
    Other

    Subject Category:
    Spine

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit- 2017

    Introduction: Lumbar stenosis (LS) is a major cause of lower back pain and functional disability. 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.

    Methods: This prospective study was conducted on 60 patients presenting to our institution. Isolated LS was suspected after physical examination and was confirmed by MRI. All our patients were treated with 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 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. Evaluation was done using 4 scales: - Visual Numerical Scale (VNS) - Roland5 Point Scale (R5PS) - Walking distance (WD) (0 to 4) - Patient satisfaction scale (PS)

    Results: Mean VNS: D0: 7,27 (4-10), D15: 3,13 (0,5 to 6), 1y: 3,45 (1 to 6) (p <0.0001) Mean R5PS: D0:4,08 (3 to 5), D15: 1,85 (0 to 3), 1y: 1,83 (1 to 4) (p<0.0001) Mean WD: D0: 1,85, D15: 3,34, 1y: 3,34 (p<0.0001) 50% amelioration of VNS: D15: 71.1%, 1y: 67.9% (p<0.0001). 50% amelioration of R5PS: D15: 75.5%, 1y: 75.5% (p<0.0001) 50% amelioration of WD: D15: 50.9%, 1y: 52.8% PS: Very good and good results=65%, Average and bad results=35%.

    Conclusions: Based on our results, ESI are efficient in LS. Our study correlates with many results in the literature although few studies were conducted exclusively on LS. We attributed the efficacy of steroids to their probable ability to block the nociceptive pathways and to their effect on prostaglandins As an alternative for medical treatment, ESI could be a promising option before indicating surgery in LS, or in surgery contraindications.

    Patient Care: It elaborates the effectiveness of a non invasive procedure as an aternative treatment for lumbar stenosis

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of lumbar epidural infiltrations in Lumbar stenosis 2) Discuss the effectiveness of epidural steroids infiltration in lumbar stenosis 3) Identify an alternative treatment fo Lumbar stenosis

    References: A radicular syndrome from developmental narrowing of the lumbar vertebral canal, 1954, Verbiest H. Clin Orthop Relat Res. 2001; (384): 3-9. The National Ambulatory Medical Care Survey (NAMCS), Hart, Deyo, and Cherkin, 1995. Lumbar spinal Stenosis, Stephane Genevay, MD and Steven J Atlas, MD, MPH, Best Pract Res Clin Rheumatol. 2010 April ; 24(2): 253–265. Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study. Y. Ishimoto y, et al., 2012. Robechhi A., Capra R. L’idrocortisone (composto F). Prime esperienze cliniche in campo reumatologico. Minerva Med 1952; 98:1259-1263 Measurement of pain using visual numeric scale, Ritter PL, Gonzalez VM, Laurent DD, Lorig KR. J Rheumatol. 2006 Mar;33(3):574-80. A retrospective analysis of the efficacy of epidural steroid injections, Rosen CD, Kahanovitz N, Bernstein R, et al; Clin Ortho 1988;228:270-2 Epidural injection in the treatment of spinal Stenosis, HoogmartensM, Morelle P; Acta Orthop Belg 1987;53:409-11 The use of epidural steroids in the treatment of lumbar radicular pain, Cuckler JM, Bernini PA, Wiesel SW, et al; J Bone Joint Surg 1985;67:63-6 Therapeutic effect and Outcome Predictors of Sciatica Treated Using Transforaminal Epidural Steroid Injection, Lee et al,. AJR 2006; 187:1427-1431 Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: An outcome study, Botwin et al. Am J Phys Med Rehabil 2002;81:898-905 Fluoroscopic transforaminal lumbar epidural steroid injections: An outcome study, Lutz GE, Vad VB, Wisneski RJ; Arch Phys Med Rehabil 1988;79:1362-66 Predictive Factors of Efficacy of Periradicular Corticosteroid Injections for Lumbar Radiculopathy, Cyteval et al. AJNR 2006; 27:978-982 Roberts S, Caterson B, Menage J, et al: Matrix metalloproteinases and aggrecanase: Their role in disorders of the human intervertebral disc. Spine 2000;25:3005–13 Epidural steroid injections, Boqing Chen, MD et al, Medscape Reference, 2011 WebMD, LLC. Lumbar epidural steroid injections in the patient with lumbar spinal Stenosis, Kenneth P. Botwin, MD, Robert D. Gruber, DO. Phys Med Rehabil Clin N Am14 (2003) 121–141 Corticosteroids in peri-radicular infiltration for radicular pain:a randomized double blind controlled trial. One year results and subgroup analysis, Suhayl Tafazal, Leslie Ng, Neeraj Chaudhary. Eur Spine J 2009 19:1220-1325 Epidural Steroid Injections Are Not Effective for Patients With Lumbar Spinal Stenosis, Steven J Atlas. Evid Based Med. 2015;20(1):16

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