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Therapeutics/Prevention
Randomised controlled trial
Epidural steroid injections are not effective for patients with lumbar spinal stenosis
Free
  1. Steven J Atlas
  1. Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to : Dr Steven Atlas, Massachusetts General Hospital, Department of Medicine, 50 Staniford Street, Room 966. Boston, MA 02114, USA; satlas{at}mgh.harvard.edu

https://doi.org/10.1136/ebmed-2014-110083

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    Commentary on: Friedly JL, Comstock BA, Turner JA, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014;371:11–21.OpenUrlCrossRefPubMedWeb of Science

    Context

    Degenerative lumbar spinal stenosis is a common cause of low back and leg pain in older individuals. The evidence supporting non-surgical treatments, including oral medications, physical treatments and spinal injections, is limited.1 Despite the lack of strong evidence supporting the use of epidural steroid injections (ESIs) for lumbar spinal stenosis, their use has increased dramatically since 2000.2 This multicentre, randomised trial compared the effectiveness of ESIs with lidocaine to epidural injections of lidocaine alone.

    Methods

    Patients were at least 50-years-old with pain and functional impairment attributable to lumbar spinal stenosis of the central canal, with no prior lumbar surgery or ESI within the past 6 months. Four hundred patients were randomly assigned to either a standard ESI (glucocorticoids) with lidocaine, or an …

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