Patient Characteristics Do Not Predict Benefit From Adding Corticosteroid to Lidocaine in Epidural Injections for Lumbar Spinal Stenosis Symptoms

Commentary by Judith Turner, PhD

Researchers found no evidence that patient characteristics are predictive of beneficial response to epidural injections of corticosteroids plus lidocaine versus lidocaine alone among patients with lumbar spinal stenosis, according to a study in the November 1 issue of The Spine Journal.
Injection being prepared in a clinical setting“Although we examined 21 patient characteristics identified in previous research as potentially predictive of treatment response, including sociodemographic characteristics, spinal canal stenosis severity as judged by the clinician based on MRI or CT findings, and psychological factors, we were unable to identify a subgroup of lumbar spinal stenosis patients likely to benefit more from an epidural injection of lidocaine plus corticosteroid than from an epidural injection of lidocaine alone,” said Judith Turner, PhD, Professor of Psychiatry and Behavioral Sciences and Rehabilitation Medicine at the University of Washington, Seattle, WA.

Impetus for the Study
“The Lumbar Epidural steroid injections for Spinal Stenosis (LESS) trial results suggested that there was little to no benefit 6 weeks later from adding corticosteroids to lidocaine in epidural injections for the treatment of lumbar spinal stenosis symptoms,” Dr. Turner said. “It has been argued that patient subgroups not analyzed in the original report of the LESS trial results might benefit from the addition of corticosteroids to epidural injections of lidocaine.”

Thus, the authors conducted secondary analyses of data from the LESS trial, in which 400 patients (age ≥ 50 years) with moderate-to-severe leg pain and central lumbar spinal stenosis were randomized to epidural injections of  a corticosteroid with lidocaine (n=200) or lidocaine only (n=200). The primary outcome measures were the Roland-Morris Disability Questionnaire (RMDQ) and a 0-10 rating of average buttock/hip/leg pain intensity in the past week.

No Predictors of Beneficial Response to Corticosteroids Found
None of the 21 patient characteristics identified in previous research as potentially predictive of treatment response were consistent predictors of benefit from epidural injection of corticosteroid+lidocaine versus lidocaine alone. These characteristics included sociodemographic characteristics, spinal canal stenosis severity, and psychological factors. Treatment response was assessed by 6 different outcome measures: RMDQ, numerical rating of average buttock/hip/leg pain intensity, Brief Pain Inventory Interference scale, Swiss Spinal Stenosis Questionnaire (SSSQ) Physical Function, SSSQ Symptom Severity, and SSSQ Satisfaction with Treatment.

Several baseline patient characteristics predicted outcomes in both treatment groups, but the relationships were modest in size and not consistent across outcome measures and time points (ie, 3 and 6 weeks).  

“These results suggest that although certain patient characteristics are associated with greater likelihood of good outcomes following either type of epidural injection for lumbar spinal stenosis symptoms (and possibly of good outcomes regardless of any treatment), there are no currently identified characteristics that predict a differential benefit from corticosteroid,” Dr. Turner concluded.

“In combination with the originally-reported findings from the LESS trial, these results are consistent with the possibility that there is no meaningful benefit for lumbar spinal stenosis symptoms from epidural injections of lidocaine with corticosteroid versus epidural injections of lidocaine only, either for patients overall or for any specific patient subgroups,” Dr. Turner added.

Updated on: 02/09/17
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