M J B Management of Lumbar Spinal Stenosis with Lumbar Epidural Steroid Injections

Degenerative lumbar stenosis is a common source of pain and disability in middle age and elderly. It presents clinically with a variety of symptoms, though neurogenic claudication is the hallmark. There is a multifactorial pathogenesis to lumbar spinal stenosis and its symptoms. Epidural steroid injections are commonly utilized to help reduce radicular pain in lumbar spinal stenosis. It can be accomplished by one of three methods: caudal (C), interlaminar (IL), or transforaminal (TF). In this study we sought to determine the efficacy of fluoroscopically guided caudal and transforaminal epidural steroid injections for the management of radicular pain associated with lumbar spinal stenosis. The outcome measures of this study are patient satisfaction, pain relief, improved function and walking tolerance. Of 42 patients included in this study 71.4% of the patients had partial to complete pain relief at 1 month compared to 57.1% at 6 months and 45.2% at 12 months. 64.2% had full or improved function at 1 month compared to 50% at 6 months and 33.3% at 12 months. 66.6% of the patients were completely or somewhat satisfied at 1 month compared to 59.5% at 6 months and 38% at 12 months. When weighing the surgical alternatives and associated risk, cost, and outcomes, lumbar epidural steroid injections are a reasonable nonsurgical option in select patients especially in those patients who are unwilling to do surgery or in whom surgery is contraindicated.