A living systematic review

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Clinical summary: This meta-analysis suggests that the clinical intervention of epidural injection of corticosteroids plus anesthetics is not effective when compared to epidural anesthetics alone. In secondary analyses, a single trial of epidural anesthetics versus epidural saline found reduced pain at one week (statistically signficant - expected to benefit 43 patients out of 100 as shown circled in red in Summary of Findings table below) and maybe at one month (statistically insignficant). However, the quality of evidence for benefit from epidural anesthetics is low due to imprecision of results and small study effect or publication bias. Future studies should focus on reduction in disability (PMID 26010037). Additional interpretations may be in the references in the 'Cited by' section below.

We included trials of epidural injections of corticosteroids as add-on therapy to usual care.

Methods overview:   Studies were abstacted into standardized tables of , and results. This repository updates a previously published meta-analysis.(1) Newer studies included are listed in the references. Rationale for newer trials excluded may be listed at the end of the references.

See methods for details.

Results: Details of the studies included are in the:

The forest plot for the primary outcome is below. Additional forest plots of secondary analyses may be available.

(Switch to interactive forest plot)
Image of forest plot of primary outcome

The Summary of Findings Table (SoF) from the GRADE Profile is below (source files). Image of GRADE Profile of primary outcome

References:

Systematic review(s)

Most recent review at time of last revision of this repository

  1. Kaye AD, Manchikanti L, Abdi S, Atluri S, Bakshi S, Benyamin RM et al. Efficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis. Pain Physician. 2015 Nov;18(6):E939-E1004. PMID: 26606031
  2. Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, Sullivan SD, Jarvik J. Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Sep 1;163(5):373-81. doi: 10.7326/M15-0934. PMID: 26302454
  3. Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med. 2015 Feb 1;5(1):e23139. doi: 10.5812/aapm.23139. PMID: 25789241; PMCID: PMC4350165
  4. Ammendolia C, Stuber KJ, Rok E, Rampersaud R, Kennedy CA, Pennick V, Steenstra IA, de Bruin LK, Furlan AD. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev. 2013 Aug 30;8:CD010712. doi: 10.1002/14651858.CD010712. PMID: 23996271.

Randomized controlled trials

New trial(s) not included in the most recent review above

  1. None

Trials undergoing review

    Jain NB, Schneider B. In Lumbar Spinal Stenosis, Adding Corticosteroids to Lidocaine Epidural Injections Did Not Improve Pain or Function at 12 Months. J Bone Joint Surg Am. 2018 May 16;100(10):884. doi: 10.2106/JBJS.18.00170. PubMed PMID: 29762288.
  1. Song SH, Ryu GH, Park JW, Lee HJ, Nam KY, Kim H, Kim SY, Kwon BS. The Effect and Safety of Steroid Injection in Lumbar Spinal Stenosis: With or Without Local Anesthetics. Ann Rehabil Med. 2016 Feb;40(1):14-20. doi: 10.5535/arm.2016.40.1.14. PMID: 26949664
  2. Makris UE, Edwards TC, Lavallee DC, Bauer Z, Comstock BA, Jarvik JGet al. Patient Priority Weighting of the Roland Morris Disability Questionnaire Does Not Change Results of the Lumbar Epidural Steroid Injections for Spinal Stenosis Trial. Spine (Phila Pa 1976). 2016 Apr 19. PMID: 27105466
    (re-analysis of Friedly trial)

Trials excluded - selected list of important trials

  1. Innovative trial design with epidural steroids plus oral placebo or sham injection plus gabapentin. However, could not isolate results for the patients with spinal stensosis: Cohen SP et al. Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study. BMJ. 2015 Apr 16;350:h1748. doi: 10.1136/bmj.h1748. PMID: 25883095
  2. Innovative trial design with the control group receiving an sham injection. However, half of patients dropped out.: Milburn J, Freeman J, Steven A, Altmeyer W, Kay D. Interlaminar epidural steroid injection for degenerative lumbar spinal canal stenosis: does the intervertebral level of performance matter? Ochsner J. 2014 Spring;14(1):62-6. PMID: 24688335
  3. Innovative trial design with the control group receiving an sham injection. However, results did not include a measure of variation to allow for pooling with other trials.: Koc Z, Ozcakir S, Sivrioglu K, Gurbet A, Kucukoglu S. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine (Phila Pa 1976). 2009 May 1;34(10):985-9. PMID: 19404172
  4. Innovative trial design with the control group receiving an sham injection. However, included patients with herniated disks and could not isolate results for the patients with spinal stensosis: Wilson-MacDonald J, Burt G, Griffin D, Glynn C. Epidural steroid injection for nerve root compression. A randomised, controlled trial. J Bone Joint Surg Br. 2005 Mar;87(3):352-5. PMID: 15773645

Funding for this review

  1. None.

Cited by

This repository is cited by:

  1. WikiDoc contributors. Spinal stenosis medical therapy. WikiDoc. Nov 9, 2014. Available at: http://www.wikidoc.org/index.php/Spinal_stenosis_medical_therapy. Accessed November 9, 2014.