The Effect of Epidural Steroid Injection on Postoperative Outcome in Patients From the Lumbar Spinal Stenosis Outcome Study.
METHODS
Retrospective analysis of data from patients participating in the Lumbar Spinal Stenosis Outcome Study (LSOS).


OBJECTIVE
The aim of LSOS was to assess clinical outcomes after surgical or nonoperative treatment in patients with and without prior epidural steroid injections.


BACKGROUND
Epidural steroid injections (ESI), a common treatment modality, reduce symptoms in the short-term, but according to a subgroup analysis from the Spine Patient Outcomes Research Trial (SPORT) they reduce the amount of improvement after subsequent surgical or nonoperative treatment.


METHODS
The data of 281 patients with lumbar spinal stenosis who had completed baseline and 6-month follow-up assessments were analyzed. Patients completed the Spinal Stenosis Measure (SSM). Changes in the SSM scores from baseline to follow-up were compared between patients with and without prior ESI, for the surgical and nonsurgical treatment groups.


RESULTS
The mean (SD) age of the patients was 75 (8.7) years. 229 patients underwent surgery and 111 of these had received an ESI in the 12 months before surgery. Of the 52 patients treated nonoperatively, 29 had received a prior ESI. The unadjusted changes (improvement) in the SSM-symptom scores between baseline and 6 months' follow up were: surgery and prior ESI 0.95, surgery and no prior ESI 0.78 (P = 0.15); no surgery and prior ESI 0.28, no surgery and no prior ESI 0.29 (P = 0.85). When adjusted for confounding factors, the reduction in SSM-symptom score was greater for surgery than for nonoperative treatment by 0.41 points (P < 0.001); the effect of having had an ESI prior to study entry was -0.08 (P = 0.40).


CONCLUSIONS
The analysis of outcomes in the LSOS cohort provided no evidence that ESIs have a negative effect on the short-term outcome of surgery or nonoperative treatment in patients with lumbar spinal stenosis.


METHODS
3.
*Schulthess Clinic, Spine Center Division, Zürich, Switzerland †Balgrist University Hospital, Department of Orthopedics, University of Zürich, Zürich, Switzerland ‡Schulthess Clinic, Department Research and Development, Spine Center Division, Zürich, Switzerland §Horten Centre for Patient Oriented Research and Knowledge Transfer, University Zürich, Zürich, Switzerland; and ¶Triemli City Hospital, Zürich, Switzerland.
Tamas
T
Fekete
Christoph
C
Woernle
Anne F
AF
Mannion
Ulrike
U
Held
Kan
K
Min
Frank
F
Kleinstück
Nils
N
Ulrich
Daniel
D
Haschtmann
Hans-Juergen
HJ
Becker
Francois
F
Porchet
Robert
R
Theiler
J
J
Steurer
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007268:Injections, Epidural; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D011300:Preoperative Care; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000188:drug therapy* / Q000601:surgery*; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D016896:Treatment Outcome
D013256:Steroids