What is the evidence for epidural injections for spinal stenosis?
AMSTAR Rating
Summary
Patient Population:
– 6 small RCT’s looked at epidural injection for spinal stenosis
– Total of 328 participants
Intervention:
– Interlaminar epidural steroid injection either blind (3 studies) or fluoroscopy (3)
Comparison:
– Local anasthetic (4 studies), PT program (1) or Intramuscular injection at site of epidural (1)
Outcome:
– Fluoroscopic epidural: Fair evidence to support improvements in pain and function
– Blind epidural: Mixed results
Guideline Recommendations
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Fluoroscopy guided injection v. Placebo
Pain and Function
Blind injection v. Placebo
Pain and Function
Relevant Clinical Info
Friedly, et al. A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis, NEJM 371;1 , 2014.
A multi-centre (16 sites), double-blinded, RCT, involving 400 participants, compared image-guided Corticosteriod and lidocaine epidural injection versus Lidocaine alone.
Primary outcomes included pain (0-10) and level of function using the Roland-Morris Disability Questionnaire (RMDQ) at 3 and 6 weeks.
The authors concluded that there was little statistical nor clinical significant difference in the primary outcomes between the two groups. However, both treatment and control groups did see improvements from baseline. Interestingly, sub-group analysis showed a stronger trend for improvement in Translaminar steroid injection versus lidocaine alone, then did Transforaminal which showed little difference.
Participant Information
of participants
were Male
the sample size was 400
Mean age of 68 years.
