Effects of Epidural Steroids in the Lumbar Spine:
A Double Blind Randomized Control Trial
CA Podium Presentation at the Amer Acad Orthop Surgeons March 10-14, 2004 · San Francisco
By Andrew Skelly
SAN FRANCISCO – A randomized, controlled trial has shown an epidural or translaminar steroid injection is ineffective for the relief of lower back pain.
"I'm not saying that steroids don't work. I'm just saying there's definite reason to question whether they work or not," Dr. Daniel Steinitz, an orthopedic surgeon at Belleville General Hospital in Ontario, said in an interview after his presentation at the American Academy of Orthopedic Surgeons meeting here.
Dr. Steinitz, who worked on the study during his residency at McGill University in Montreal, said steroid injections for lumbar pain are popular but research on their use over the past 40 years has produced conflicting results. Nor is the procedure benign, with dural puncture leading to headache being one of the more common complications.
The study involved 50 consecutive patients who were referred to an interventional radiologist for a translaminar block or selective nerve root block. The patients' pathology had been confirmed by CT or MRI and none had undergone spine surgery or had previous injections.
All patients received an epidural injection of lidocaine and bupivacaine and a radio-opaque dye to confirm the accuracy of the injection under fluoroscopy. In addition, patients randomly assigned to the steroid arm received 12 mg betamethasone.
A research assistant evaluated the patients two weeks before their injection and three and 16 weeks afterward.
Both the radiologist and the evaluator were blinded to the treatment type.
Although the procedure helped relieve back pain in both groups, there were no differences between the two groups at any visit on any of the outcome measures, which included the Musculoskeletal Functional Assessment, Bother Index, Functional Index, Oswestry Score and Visual Pain Analogue Score.
Dr. Steinitz said the study was felt to be large enough to show a significant advantage of steroid injections, if there was one, but he added there are other variables that need to be followed up in other studies, such as the number of injections and dose of steroid.
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