The Effectiveness of Epidural Steroids in the Treatment of Degenerative Spondylolisthesis: A Prospective Analysis

D.C. Sutton, M.D.
T.J. Albert, M.D.
R.A. Balderston, M.D.
L.Wang, M.D.
S.S.Han, M.D.
D. Jaffe, B.S.

Purpose
To evaluate the effectiveness of epidural steroids in the treatment of degenerative spondylolisthesis with lumbar radiculopathy using a pre-injection epidurogram to confirm localization of the injection.

Methods
Sixty-three patients were treated prospectively with epidural injections consisting of a 7 cc mixture of Celestone Soluspan and Sensorcaine. Prior to each injection, 5 cc's of contrast dye was used to perform an epidurogram to confirm localization of the injection. All patients had radiographic confirmation of a degenerative spondylolisthesis and complaints of neurogenic claudication or radiculopathy correlating with the level of the degenerative slip. Short and long term efficacy was prospectively evaluated by independent repetitive follow-up interviews and clinical exams.

Results
All injections were technically successfully administered into the epidural space as verified by epiduography. Short term follow-up of one week demonstrated significant relief of pain in 71% of patients and no relief in 29%. Longer term follow-up (10 months to 24 months) demonstrated 42% with significant relief of pain and 58% with no relief. Of those patients without long term relief, 57% went on to have surgical intervention with relief of symptoms. Degree of slippage or degeneration did not correlate with or prognosticate relief after epidural steroid injection.

Discussion
This represents the first study to evaluate confirmed epidural steriod injections in a known diagnostic entity (degenerative spondylolisthesis with neurogenic claudication/radiculopathy). The use of pre-injection epidurogram was used in this study to confirm localization of the injection in all subjects. Good short term relief was achieved with this technique. However, long term relief appears to occur in less than 50% of patients. As yet we are unable to predict who will improve from this intervention.

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