title: Results of 2-year follow-up of a randomized, double-blind, controlled trial of fluoroscopic caudal epidural injections in central spinal stenosis.
abstract: BACKGROUND
  Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, there is a paucity of literature concerning the treatment of spinal stenosis symptoms. Multiple interventions, including surgery and interventional techniques such as epidural injections and adhesiolysis, are commonly utilized in managing pain related to central spinal stenosis. However, there is a paucity of literature from randomized, controlled trials about the effectiveness of epidural injections for lumbar central spinal stenosis.
  
  
  OBJECTIVE
  This study sought to assess the effectiveness of caudal epidural injections with or without steroids in providing effective and long-lasting pain relief for the management of chronic low back pain related to lumbar central stenosis.
  
  
  METHODS
  A randomized, double-blind, active-controlled trial.
  
  
  METHODS
  One hundred patients were randomly assigned to one of 2 groups, with Group I patients receiving caudal epidural injections of local anesthetic  (lidocaine 0.5%), whereas Group II patients received caudal epidural injections with 0.5% lidocaine 9 mL mixed with 1 mL of steroid, 6 mg  (non-particulate betamethasone).
  
  
  METHODS
  Multiple outcome measures, including the Numeric Rating Scale  (NRS), the Oswestry Disability Index 2.0  (ODI), employment status, and opioid intake were utilized. Assessments were carried out at 3, 6, 12, 18, and 24 months posttreatment.  The primary outcome was defined as pain relief and improvement in disability scores of 50% or more. Successful treatment was considered as at least 3 weeks of relief following the first 2 injections, categorizing these patients into a successful group, and others into a failed group.
  
  
  RESULTS
  Significant pain relief and functional status improvement were seen in 51% in Group I and 57% in Group II at the end of 2 years in the successful group when the participants were separated into successful and failed groups. However, overall, significant pain relief and functional status improvement  (≥ 50%) was demonstrated in 38% in Group I and 44% in Group II at the end of 2 years. The overall number of procedures for 2 years were 4 in both groups, with 5 procedures on average in the successful groups, and approximately 60 weeks of relief in Group I and 54 weeks of relief in Group II at 2 years in the successful group.
  
  
  CONCLUSIONS
  Caudal epidural injections of local anesthetic with or without steroids provide relief in a modest proportion of patients undergoing the treatment and may be considered as an effective treatment for a select group of patients who have chronic function-limiting low back and lower extremity pain secondary to central spinal stenosis.
authors.affiliation: Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cash
authors.forename: Carla D
authors.initials: CD
authors.lastname: McManus
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
authors.forename: Bert
authors.initials: B
authors.lastname: Fellows
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D008012:Lidocaine / Q000627:therapeutic use*; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D059408:Pain Management; D013130:Spinal Stenosis / Q000150:complications / Q000188:drug therapy*; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D013256:Steroids; D008012:Lidocaine