Background Lumbar spinal stenosis (LSS) is a common degenerative disease. Treatment modalities for LSS vary and include medication, exercise, interventional techniques, and surgery. Epidural steroid injection has been used for the treatment of LSS with variable results. The relationship between severity of lumbar spinal stenosis and efficacy of lumbar epidural steroid injection is still undetermined.
Objectives The aim of our study was to determine the relationship between the severity of LSS using MRI grading system and the response to lumbar epidural steroid injection.
Methods Thirty patients with degenerative LSS were enrolled in this prospective study. All subjects underwent lumbar spine MRI (T2-weighted axial images). LSS was graded using MRI grading system (grade 1 = mild stenosis with separation of all cauda equine; grade 2 = moderate stenosis with some cauda equine aggregated; grade 3 = severe stenosis with none of the cauda equine separated). All fluoroscopy guided transforaminal epidural steroid injections (FG- TFESI) were performed in the procedure room. Outcome measures were obtained using the visual analogue scale (VAS) for both back and leg pain, Oswestry disability index (ODI), Roland 5-point pain scale, walking tolerance and patient's satisfaction scale at 2 and 8 weeks post-treatment.
Results Thirty LSS patients treated with FG- TFESI, who were completely followed up, were included in this study, the injection rate was one injection per patient. The patients were followed at 2 weeks and 8 weeks. Fifty-six percent of patients at 2 weeks and 70%% at 8 weeks had a successful outcome, reporting at least a >50% reduction between pre-injection and post-injection visual analogue pain scores.Roland 5 point pain scale showed pain reduction in 50% of patients by (26%) at 2 weeks and in 70% of patients by50%pain reduction at 8 weeks. Oswestry low back pain disability questionnaire (ODI) scores showed statistically significant improvement from initial scores to 2 weeks and from to 8 weeks in 70% of patients. Walking tolerance showed improvement at 2 weeks in 50% of patients and at 8 weeks in 70% of patients. The outcome was statistically significant even in severe stenotic patients when comparing initial scores of moderate and severe stenosis at 2 weeks and 8 weeks scores in walking tolerance (P=0.006), Back VAS (P=0.717), Leg VAS (P=0.139), ODI (0.139), and Roland (P=0.001).
Conclusions FG-LESI may reduce pain and improve walking tolerance in the short term for the treatment of patients with LSS for a period of 8 weeks. The outcome does not seem to correlate with the degree of lumbar spinal stenosis. Patients with severe LSS may have the same chance to get benefits from FG-LESI as patients with moderate LSS.
Disclosure of Interest None declared