Open AccessLumbar Interlaminar Epidural Injections in Central Spinal Stenosis: Preliminary Results of a Randomized, Double-Blind, Active Control Trial
Author(s) -
Laxmaiah Manchikanti,
Cash Ka,
McManus Cd,
Damron Ks,
Pampati,
Falco Fj
Publication year - 2012
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2012/15/51
Subject(s) - medicine , oswestry disability index , interventional pain management , lumbar , randomized controlled trial , anesthesia , local anesthetic , spinal stenosis , low back pain , back pain , betamethasone , radicular pain , surgery , physical therapy , pain management , alternative medicine , pathology
Background: Chronic, persistent low back and lower extremity pain is often caused by spinalstenosis. Surgery and other interventions, including epidural injections, have been used torelieve this pain. However, there is little in the medical literature to support interlaminar, ortransforaminal epidural injections under fluoroscopy for managing lumbar pain of centralspinal stenosis, while the caudal epidural approach has been studied.Study Design: A randomized, double-blind, active control trial.Setting: A private, interventional pain management practice, specialty referral center in theUnited States.Objective: This study sought to determine if low back and lower extremity pain secondaryto lumbar central stenosis can be managed and long-lasting pain relief can be achieved withinterlaminar epidural injections of local anesthetic, with or without steroids.Methods: The study comprised 2 groups: one that received local anesthetic only and anotherreceived local anesthetic combined with nonparticulate betamethasone.A total of 120 patients were randomized by a computer-generated random allocationssequence to one of the 2 groups. The results of 30 patients in each group were assessed.Outcomes Assessment: Sixty patients were included in this analysis. Outcomesmeasurements were taken at baseline and at 3, 6, and 12 months post-treatment.Measurements taken were Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI),employment status and opioid intake. A decrease in both the NRS and ODI of ≥ 50% wasconsidered significant.Results: Significant pain relief and improvement in ODI scores were seen in both groups at12 months. Group I’s significant pain relief was 70%; Group II’s was 63%. The significant ODIimprovement in Group I was 70%; in Group II it was 60%. Group I patients on average received3.8 procedures a year; Group II patients received 4.0 procedures a year in successful group. Over52 weeks in the successful group, total relief for Group I was 40.8 ± 11.7 weeks; for Group II itwas 37.1 ± 12.6 weeks. Combined pain relief and functional status improvement were seen in80% of patients in Group I and 72% in Group II in successful group.Limitations: The lack of a placebo group and preliminary results are limitations.Conclusion: Patients might benefit from receiving lumbar interlaminar injections with orwithout steroids for lumbar central spinal stenosis.Key words: Chronic low back pain, lower extremity pain, lumbar spinal stenosis, centralstenosis, lumbar interlaminar epidural injections, epidural steroids, local anesthetic.