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The Effect of Epidural Steroid Injection on Postoperative Outcome in Patients From the Lumbar Spinal Stenosis Outcome Study

Fekete, Tamas MD*; Woernle, Christoph MD; Mannion, Anne F. PhD; Held, Ulrike PhD§; Min, Kan MD; Kleinstück, Frank MD*; Ulrich, Nils MD; Haschtmann, Daniel MD*; Becker, Hans-Juergen MD*; Porchet, Francois MD*; Theiler, Robert MD; Steurer, J. MD§on behalf of the LSOS Working Group

doi: 10.1097/BRS.0000000000000969

Study Design. Retrospective analysis of data from patients participating in the Lumbar Spinal Stenosis Outcome Study (LSOS).

Objective. The aim of LSOS was to assess clinical outcomes after surgical or nonoperative treatment in patients with and without prior epidural steroid injections.

Summary of Background Data. Epidural steroid injections (ESI), a common treatment modality, reduce symptoms in the short-term, but according to a subgroup analysis from the Spine Patient Outcomes Research Trial (SPORT) they reduce the amount of improvement after subsequent surgical or nonoperative treatment.

Methods. The data of 281 patients with lumbar spinal stenosis who had completed baseline and 6-month follow-up assessments were analyzed. Patients completed the Spinal Stenosis Measure (SSM). Changes in the SSM scores from baseline to follow-up were compared between patients with and without prior ESI, for the surgical and nonsurgical treatment groups.

Results. The mean (SD) age of the patients was 75 (8.7) years. 229 patients underwent surgery and 111 of these had received an ESI in the 12 months before surgery. Of the 52 patients treated nonoperatively, 29 had received a prior ESI. The unadjusted changes (improvement) in the SSM-symptom scores between baseline and 6 months' follow up were: surgery and prior ESI 0.95, surgery and no prior ESI 0.78 (P = 0.15); no surgery and prior ESI 0.28, no surgery and no prior ESI 0.29 (P = 0.85). When adjusted for confounding factors, the reduction in SSM-symptom score was greater for surgery than for nonoperative treatment by 0.41 points (P < 0.001); the effect of having had an ESI prior to study entry was −0.08 (P = 0.40).

Conclusion. The analysis of outcomes in the LSOS cohort provided no evidence that ESIs have a negative effect on the short-term outcome of surgery or nonoperative treatment in patients with lumbar spinal stenosis.

Level of Evidence: 3

The aim of this study was to assess the clinical outcome of patients with lumbar spinal stenosis undergoing surgical or nonoperative treatment, with or without prior epidural steroid injection. The analysis provided no evidence that epidural steroid injections have a negative eff ect on the short-term outcome in these patients.

*Schulthess Clinic, Spine Center Division, Zürich, Switzerland

Balgrist University Hospital, Department of Orthopedics, University of Zürich, Zürich, Switzerland

Schulthess Clinic, Department Research and Development, Spine Center Division, Zürich, Switzerland

§Horten Centre for Patient Oriented Research and Knowledge Transfer, University Zürich, Zürich, Switzerland; and

Triemli City Hospital, Zürich, Switzerland.

Address correspondence and reprint requests to Johann Steurer, MD, Horten Centre, University Zürich, Pestalozzistrasse 24, CH 8091 Zürich, Switzerland; E-mail

Acknowledgment date: January 15, 2015. First revision date: March 24, 2015. Acceptance date: April 8, 2015.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Pfizer-Foundation for geriatrics and research in geriatrics and the Helmut Horten Foundation funds were received in support of this work.

Relevant financial activities outside the submitted work: grants, payment for lectures.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.