title: A randomized trial of epidural glucocorticoid injections for spinal stenosis.
abstract: BACKGROUND
  Epidural glucocorticoid injections are widely used to treat symptoms of lumbar spinal stenosis, a common cause of pain and disability in older adults. However, rigorous data are lacking regarding the effectiveness and safety of these injections.
  
  
  METHODS
  In a double-blind, multisite trial, we randomly assigned 400 patients who had lumbar central spinal stenosis and moderate-to-severe leg pain and disability to receive epidural injections of glucocorticoids plus lidocaine or lidocaine alone. The patients received one or two injections before the primary outcome evaluation, performed 6 weeks after randomization and the first injection. The primary outcomes were the score on the Roland-Morris Disability Questionnaire (RMDQ, in which scores range from 0 to 24, with higher scores indicating greater physical disability) and the rating of the intensity of leg pain (on a scale from 0 to 10, with 0 indicating no pain and 10 indicating "pain as bad as you can imagine").
  
  
  RESULTS
  At 6 weeks, there were no significant between-group differences in the RMDQ score (adjusted difference in the average treatment effect between the glucocorticoid-lidocaine group and the lidocaine-alone group, -1.0 points; 95% confidence interval [CI], -2.1 to 0.1; P=0.07) or the intensity of leg pain (adjusted difference in the average treatment effect, -0.2 points; 95% CI, -0.8 to 0.4; P=0.48). A prespecified secondary subgroup analysis with stratification according to type of injection (interlaminar vs. transforaminal) likewise showed no significant differences at 6 weeks.
  
  
  CONCLUSIONS
  In the treatment of lumbar spinal stenosis, epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone. (Funded by the Agency for Healthcare Research and Quality; ClinicalTrials.gov number, NCT01238536.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: Janna L
authors.initials: JL
authors.lastname: Friedly
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Comstock
authors.forename: Judith A
authors.initials: JA
authors.lastname: Turner
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Zoya
authors.initials: Z
authors.lastname: Bauer
authors.forename: Brian W
authors.initials: BW
authors.lastname: Bresnahan
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Avins
authors.forename: Srdjan S
authors.initials: SS
authors.lastname: Nedeljkovic
authors.forename: David R
authors.initials: DR
authors.lastname: Nerenz
authors.forename: Christopher
authors.initials: C
authors.lastname: Standaert
authors.forename: Larry
authors.initials: L
authors.lastname: Kessler
authors.forename: Venu
authors.initials: V
authors.lastname: Akuthota
authors.forename: Thiru
authors.initials: T
authors.lastname: Annaswamy
authors.forename: Allen
authors.initials: A
authors.lastname: Chen
authors.forename: Felix
authors.initials: F
authors.lastname: Diehn
authors.forename: William
authors.initials: W
authors.lastname: Firtch
authors.forename: Frederic J
authors.initials: FJ
authors.lastname: Gerges
authors.forename: Christopher
authors.initials: C
authors.lastname: Gilligan
authors.forename: Harley
authors.initials: H
authors.lastname: Goldberg
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
authors.forename: Shlomo
authors.initials: S
authors.lastname: Mandel
authors.forename: Mark
authors.initials: M
authors.lastname: Tyburski
authors.forename: William
authors.initials: W
authors.lastname: Sanders
authors.forename: David
authors.initials: D
authors.lastname: Sibell
authors.forename: Matthew
authors.initials: M
authors.lastname: Smuck
authors.forename: Ajay
authors.initials: A
authors.lastname: Wasan
authors.forename: Lawrence
authors.initials: L
authors.lastname: Won
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007268:Injections, Epidural; D008012:Lidocaine / Q000009:adverse effects / Q000627:therapeutic use*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D013130:Spinal Stenosis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D008012:Lidocaine; D006854:Hydrocortisone