Epidural Steroid Injections Could Help Avoid Surgery

For patients with lower back pain, epidural steroid injections (ESI) could reduce the need for surgery, according to a new study.

Researchers at Massachusetts General Hospital (Boston, USA) conducted a systematic review and meta-analysis of studies to determine whether ESI could have a surgery-sparing effect in patients with spinal pain. Databases searched included Cochrane, PubMed, and EMBASE. The primary analysis evaluated randomized controlled trials (RCTs) in which treatment groups received ESI and control groups underwent control injections. Secondary analyses involved RCTs comparing surgery with ESI or conservative treatment in which the operative disposition of subjects who received ESI was evaluated.

The researchers found that only those studies that there was moderate evidence that patients receiving ESI versus control treatment were less likely to undergo surgery. For studies examining surgery as a secondary outcome, there was a trend toward reduction in the need for surgery for short-term, but not long-term (at least one year) outcomes. Low-level evidence suggested that between one-third and one-half of patients considering surgery could avoid surgery with ESIs. The study was published in the February 1, 2015, issue of the Spine Journal.

“Low back pain is debilitating and costly, especially for patients not responding to conservative therapy and requiring surgery,” concluded lead author Mark Bicket, MD, and colleagues. “Epidural steroid injections may provide a small surgery-sparing effect in the short term compared with control injections, and reduce the need for surgery in some patients who would otherwise proceed to surgery.”

An ESI can help relieve pain caused by spinal stenosis, spondylosis, or disc herniation by delivering medication to the spinal nerve through the epidural space. It usually includes both a long-lasting corticosteroid (such as triamcinolone or betamethasone) and an anesthetic numbing agent (lidocaine or bupivacaine). The effects of ESI tend to be temporary, with the goal being to reduce pain so that a person may resume normal activities and a physical therapy program.

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