Editor’s Choice: Lumbar Spinal Stenosis Severity by CT or MRI Does Not Predict Response to Epidural Corticosteroid versus Lidocaine Injections

Editor’s Choice

In this secondary analysis of the CT and MR imaging studies of the prospective, double-blind Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS) trial participants, the authors found no differences in baseline imaging characteristics between those receiving epidural corticosteroid and lidocaine and those receiving lidocaine alone injections. No imaging measures of spinal stenosis were associated with a differential response to corticosteroids, indicating that imaging parameters of spinal stenosis did not predict a response to epidural corticosteroids.

Abstract

BACKGROUND AND PURPOSE

Mean and 95% CI for the RDQ disability score (A) and the leg pain NRS (B) are presented at baseline, 3 weeks, and 6 weeks following epidural injection, including all patients regardless of injectate type, and subdivided by the severity of spinal stenosis on imaging (mild = solid line with circle; moderate = dash line with square; severe = dotted line with triangle).

Epidural steroid injections may offer little-to-no short-term benefit in the overall population of patients with symptomatic spinal stenosis compared with lidocaine alone. We investigated whether imaging could identify subgroups of patients who might benefit most.

MATERIALS AND METHODS

A secondary analysis of the Lumbar Epidural Steroid Injections for Spinal Stenosis prospective, double-blind trial was performed, and patients were randomized to receive an epidural injection of lidocaine with or without corticosteroids. Patients (n = 350) were evaluated for qualitative and quantitative MR imaging or CT measures of lumbar spinal stenosis. The primary clinical end points were the Roland-Morris Disability Questionnaire and the leg pain numeric rating scale at 3 weeks following injection. ANCOVA was used to assess the significance of interaction terms between imaging measures of spinal stenosis and injectate type on clinical improvement.

RESULTS

There was no difference in the improvement of disability or leg pain scores at 3 weeks between patients injected with epidural lidocaine alone compared with corticosteroid and lidocaine when accounting for the primary imaging measures of qualitative spinal stenosis assessment (interaction coefficients for disability score, −0.1; 95% CI, −1.3 to 1.2; P = .90; and for the leg pain score, 0.1; 95% CI, −0.6 to 0.8; P = .81) or the quantitative minimum thecal sac cross-sectional area (interaction coefficients for disability score, 0.01; 95% CI, −0.01 to 0.03; P = .40; and for the leg pain score, 0.01; 95% CI, −0.01 to 0.03; P = .33).

CONCLUSIONS

Imaging measures of spinal stenosis are not associated with differential clinical responses following epidural corticosteroid injection.

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Editor’s Choice: Lumbar Spinal Stenosis Severity by CT or MRI Does Not Predict Response to Epidural Corticosteroid versus Lidocaine Injections
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