This is the medical model for treating low back and leg pain that is caused by spinal stenosis (pictured, here) – a narrowing of the space that the spinal cord or nerve root passes through:
- Try exercises and physical therapy first.
- If you are still having more problems than you can deal with, try an epidural injection of steroids at the pain clinic.
- When that doesn’t help, surgery is then offered to open up the space.
A small study published in the February 2014 issue of the journal Spine suggests that the injections may do more harm than good!
The Spine Patient Outcomes Research Trial (SPORT) was a four year comprehensive study to look at different ways of treating low back and leg pain and how effective they were for patients, funded by the National Institutes of Health (NIH). Some patients had surgery, others had non-surgical interventions, and the research published from the trial said, basically, that those who had surgery were, by and large, happier with their results one to four years later than those who didn’t.
Researchers with access to the SPORT database took a look at the results from a group of those non-surgical patients, specifically those patients with lumbar spinal stenosis, to see how the patients who received epidural steroid injection compared to those who didn’t.
There were 276 patients in the original SPORT study who had the diagnosis of lumbar spinal stenosis, and the data from this subgroup was analyzed to see how well the 69 who received the epidural steroid injections within the first 3 months of the study did, compared to the 207 who didn’t have the injections.
The conclusions? Pretty scary if you’ve already had the injections!
- Those patients who had epidural steroid injection were associated with significantly less improvement at 4 years among all patients with spinal stenosis in SPORT.
- Furthermore, for those who eventually had surgery, having epidural steroid injections were associated with longer duration of surgery and longer hospital stay.
- There was no improvement in outcome with epidural steroid injection whether patients were treated surgically or non-surgically.
In case you didn’t catch it: At the end of four years, everyone who had the injections had significantly less improvement than those who didn’t have them (whether they ended up in surgery or not).
Okay. Yes, this is a small study. Yes, it only studied the people with one of the possible causes for low back/leg pain. Do you really want to have such an injection IN CASE they find something different when they look at the rest of the population?
Should you have epidural steroid injections as part of the recommended course of treatment for your low back pain? I think not.