Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis

Drug Des Devel Ther. 2015 Jan 30:9:707-16. doi: 10.2147/DDDT.S78070. eCollection 2015.

Abstract

Purpose: To investigate the effectiveness and safety of epidural steroid injections in patients with lumbar spinal stenosis (LSS).

Methods: We performed a search on the CENTRAL, Pubmed, Embase and Cochrane databases up to September 2014. We recovered 17 original articles, of which only 10 were in full compliance with the randomized controlled trial (RCT) criteria. These articles were reviewed in an independent and blinded way by two reviewers who were previously trained to extract data and score their quality by the criteria of the Cochrane Handbook (5.1.0).

Results: We accepted ten studies with 1,010 participants. There is minimal evidence that shows that epidural steroid injections are better than lidocaine alone, regardless of the mode of epidural injection. There is a fair short-term and long-term benefit for treating spinal stenosis with local anesthetic and steroids.

Conclusions: This meta-analysis suggests that epidural steroid injections provide limited improvement in short-term and long-term benefits in LSS patients.

Keywords: chronic pain; epidural injection; local anesthetic; lumbar spinal stenosis; steroid.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anesthetics, Local / administration & dosage
  • Back Pain / diagnosis
  • Back Pain / drug therapy*
  • Back Pain / etiology
  • Back Pain / physiopathology
  • Humans
  • Injections, Spinal
  • Lumbar Vertebrae / drug effects*
  • Lumbar Vertebrae / physiopathology
  • Pain Measurement
  • Patient Safety
  • Recovery of Function
  • Risk Assessment
  • Risk Factors
  • Spinal Stenosis / complications
  • Spinal Stenosis / diagnosis
  • Spinal Stenosis / drug therapy*
  • Spinal Stenosis / physiopathology
  • Steroids / administration & dosage*
  • Steroids / adverse effects
  • Treatment Outcome

Substances

  • Anesthetics, Local
  • Steroids