Fluoroscopic Caudal Epidural Injections With or Without Steroids in Managing Pain of Lumbar Spinal Stenosis One-Year Results of Randomized, Double-Blind, Active-Controlled Trial

Study Design: A randomized, double-blind, active-controlled trial. Objective: To evaluate the effectiveness of caudal epidural injections with or without steroids in providing effective and long-lasting pain relief in the management of chronic low back pain related to lumbar spinal stenosis. Summary of Background Data: Multiple interventions including surgery and interventional techniques such as epidural injections and adhesiolysis are commonly performed in managing pain related to spinal stenosis. There is continuing debate on the effectiveness of all interventions, and a paucity of literature regarding effectiveness. Methods: One-hundred participants were randomly assigned to 1 of the 2 groups, with Group I participants receiving caudal epidural injections of local anesthetic (lidocaine 0.5%), whereas Group II participants received caudal epidural injections with 0.5% lidocaine 9mL mixed with 1mL of steroid (nonparticulate Celestone). Outcomes Assessment: Multiple outcome measures were used, including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12 months posttreatment. Significant pain relief and improvement in disability were defined as 50% or more. Results: Overall, significant pain relief and functional status improvement (>= 50%) were demonstrated in 48% in Group I and 46% in Group II. However, significant pain relief and functional status improvement were seen in 60% of the participants in both groups in the successful category when the participants were separated into successful and failed categories. The overall number of procedures was 3.1 +/- 1.3 or 3.6 +/- 1.1 in the successful category in Group I, with overall 2.9 +/- 1.4 or 3.5 +/- 1.2 in the successful category in Group II. Conclusion: Caudal epidural injections of local anesthetic with or without steroids may be an effective treatment for a select group of patients with chronic function-limiting low back and lower extremity pain secondary to spinal stenosis.