Women’s Health: Epidural Injections and Spinal Stenosis
By Ryan Overton DC, West Georgia Chiropractic
Every year, millions of people get steroid injections to treat the pain associated with pinched nerves in the lower back also called spinal stenosis. Although epidural injections might be appropriate for some conditions, according to research spinal stenosis would not be among them.
Injecting steroids into the backs of patients suffering from spinal stenosis or narrowing of the nerve pathways is a very common practice. Stenosis can cause back pain, leg pain, and many other symptoms as the nerves become trapped and pinched. Epidural steroid injections (ESI) are performed by most, if not all, orthopedic specialists, and the practice has spread to primary care and family physicians.
The new study, published in Spine and led by Dr. Kris Radcliff, an orthopedic surgeon at the Rothman Institute in Philadelphia, looked at the long-term outcomes among patients taking part in the Spine Outcomes Research Trial (SPORT), one of the largest clinical trials of spinal surgeries ever undertaken.
The SPORT trial enlisted patients with spinal stenosis. Dr. Radcliff and his research team analyzed the records of 69 patients who underwent epidural steroid injections during their first three months of enrollment in SPORT, and compared their experience with 207 patients who did not receive ESI. The two groups were otherwise medically similar.
The results were a big surprise to everyone involved in the study. But the evidence was clear. Patients who had the steroid injections but didn’t have surgery, experienced less improvement in both pain and functioning than those who did not have the injections.
- Patients who had the steroid injections but didn’t have surgery, experienced less improvement in both pain and functioning than those who did not have the injections.
- There was no evidence that ESI helped any patients avoid surgery. Back surgery is notoriously invasive, inconsistent and expensive, and has less than optimal results over a period of time.
- For patients who had steroid injections and later had surgery, the surgery was more complicated and took longer than for those who did not have the injections. Those patients also showed less improvement in physical functioning over a four-year follow-up.
- The steroid injections appear to worsen the stenosis. Intended to benefit the patient, instead it appears to speed up the narrowing process and reduce the chances of recovery.
Whether surgery is performed or not, says the Radcliff study, epidural steroid injections are simply a bad idea right from the get-go. “Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis,” the authors said. “Furthermore, ESIs were associated with longer duration of surgery and longer hospital stay. There was no improvement in outcome with ESI whether patients were treated surgically or non-surgically.”
Earlier this year, the federal government granted an award to a chiropractor to study the effects of Chiropractic on lumbar spinal stenosis. This was the first federal award given to a chiropractor and was granted because of the numerous studies showing the success of Chiropractic treatment on back problems. One of the studies, a pilot study reported by Wellmark Blue Cross and Blue Shield Collaboration on Quality® Physical Medicine Pilot on Quality, showed that of the 5,500 participants, those who received treatment from chiropractors, physical therapists and occupational therapists for their back problems reported at least 30 percent improvement within 30 days of initial treatment.
Another study showed that if you have back pain and see a chiropractor before seeing a surgeon, there is only a 1.5 percent chance you’ll have surgery later. However, if you see a surgeon first, your chances of having surgery increase to 47.5 percent.
If you or someone you care about is suffering from lower back pain speak with your chiropractor first. If further treatment is needed, your chiropractor will make sure you know about it and help you find the best options.
More information
For any questions about your health or if you need help with your back pain contact Dr. Ryan Overton’s office at 706-660-0777.
SOURCES: Kris Radcliff, M.D., Rothman Institute, Thomas Jefferson University, Philadelphia; Steven P. Cohen, M.D., professor, Johns Hopkins School of Medicine, Baltimore; Eric Mayer, M.D., director, outcomes, Cleveland Clinic Center for Spine Health, Ohio; Feb. 15, 2013, Spine
