Eku Oben, Mercer University College of Pharmacy
Lumbar spinal stenosis is the narrowing of the space around the spinal cord, most commonly caused by arthritis.  Guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, corticosteroid injections, anesthetic injections, physical therapy, or a lumbar brace for treatment of lumbar spinal stenosis.  Comparing lumbar spinal stenosis patient pain scores shows no difference between groups that received steroid injections after anesthesia and placebo groups at the first month (p= 0.793). 
|Design||Multicenter, double-blind, randomized controlled trial; N= 400|
|Objective||To determine the effectiveness of treatment with epidural corticosteroid injection for lumbar spinal stenosis, and the effect of repeat injections|
|Study Group||Epidural injections with corticosteroid plus lidocaine (n= 200); lidocaine alone (n= 200)|
|Methods||Participants completed a Roland-Morris Disability Questionnaire (higher scores indicating disability ranged from 0 – 24) and leg pain intensity ranged from 0 (no pain) to 10 (worst pain).
Participants received two epidural injections during the initial six weeks of the study, before another two injections were added (between months six and 12).
Daily logs were used to measure the use of anesthetics, and results were recorded using electronic medical records and patient self-reported pain diaries.
|Primary Outcome Measure||A high questionnaire score indicating disability and intense leg pain|
|Results||Injections by randomized treatment group
|Adverse Effects||Common: none reported|
|Serious: none reported|
|Percentage that discontinued due to adverse events: none reported|
|Study Author Conclusions||No additional benefit is seen when treating patients with lumbar central canal spinal stenosis with epidural injections of corticosteroids plus lidocaine, compared to the when lidocaine is used alone from six to 12 months.|
This study shows no significant difference between the lidocaine plus corticosteroid group compared to the lidocaine group alone, or leg pain. 46.5% of participants in the “lidocaine alone” group had >50% improvement in leg pain by the end of the study, compared to 36.7% in the lidocaine plus corticosteroid group. However, this data was not statistically significant.  The study was based on participants responses, which could be a limitation because of recall bias. In addition, the study did not include patients who had herniated disk pain or foraminal stenosis, which could be a limitation for an accurate study population.
 Lumbar spinal stenosis. American Academy of Orthopedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00329. Updated December 2013. Accessed September 2, 2017.
 Spinal stenosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health_info/spinal_stenosis/. Accessed September 1, 2017.
 Song SH, Ryu GH, Park JW, et al. The effect and safety of steroid injection in lumbar spinal stenosis: with or without local anesthetics. Ann Rehabil Med. 2016;40(1):14-20.
 Friedly JL, Comstock BA, Turner JA, et al. Long-term effects of repeated injections of local anesthetic with or without corticosteroid for lumbar spinal stenosis. Arch Phys Med Rehabil. 2017;98(8):1499-1507.