Injections to Treat Spinal Stenosis
Degenerative lumbar spinal stenosis (LSS) is a condition that involves narrowing of the spinal canal. When the spinal canal narrows for any reason, the spinal nerves inside can become pinched. This can cause serious low back and leg pain. LSS has many different causes. Sometimes surgery can help. However, surgery is not always possible. And in some patients, nonsurgical methods can work over time.

There is no one best way to treat LSS nonsurgically. Many different treatments can help relieve pain, including epidural steroid injections (ESIs). When doctors give an ESI, they inject numbing medication and a steroid into the painful part of the lumbar spine. ESIs are used fairly often for LSS, but there is not much research on how well they really work.

These researchers interviewed 140 patients with LSS who had an ESI done at the same spine center. The patients were all older than 55. Over three years, they had one to seven ESIs for pain. The researchers asked them questions about pain, function, and their satisfaction with treatment.

Results showed that 20 percent of the LSS patients had gone on to have surgery. About 71 percent reported at least some improvement from ESIs; 32 percent reported more than two months of pain relief. About half of the patients still reported some pain relief and better function an average of 18 months later. Almost half said they were very satisfied with the results of their ESIs, while 74 percent were at least somewhat satisfied. In this study, gender, age, and other health problems didn't seem to be linked to results.

These are better outcomes than earlier studies. The authors aren't exactly sure why. They note that this was the only study to use a special imaging device called a fluoroscope. The fluoroscope lets the doctor make sure the needle is in the correct place before giving the injection.

The authors conclude that ESIs can be a useful part of a treatment program for patients with LSS. They say ESIs can be most helpful in getting patients through flares-ups of pain.
Elva G. Delport, MD, et al. Treatment of Lumbar Spinal Stenosis with Epidural Steroid Injections: A Retrospective Outcome Study. In Archives of Physical Medicine and Rehabilitation. March 2004. Vol. 85. No. 3. Pp. 479-484.