Epidural steroid injections, a procedure commonly used to treat back pain, may do more harm than good for patients with spinal stenosis, according to a new study in the journal Spine.
Spinal stenosis is a narrowing of the open spaces in the spine, often caused by wear-and-tear changes associated with aging. The narrowing puts pressure on the spinal cord, causing back pain, leg pain and other symptoms. Epidural steroids injections (ESI) are often prescribed to treat pain in the early stages of spinal stenosis, as an alternative to surgery.
“There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically,” wrote to lead author Kris E. Radcliff, MD, of Thomas Jefferson University, in Philadelphia.
Radcliff and his colleagues compared clinical outcomes of 69 patients who had a steroid injection in the first three months of treatment to 207 patients who did not have ESI. Both groups were also treated with surgery, physical therapy or pain medications.
Among the patients who had surgery, those who had ESI showed less improvement in physical functioning four years later. For those treated non-surgically, steroid injections were associated with less improvement in pain as well as functioning.
Radcliff and his colleagues theorize that while injecting a steroid and an analgesic into the spine may temporarily relieve pain, in the long run the injection could make the spinal stenosis worse.
“ESIs may temporarily diminish pain but may actually potentiate damage to the nerve roots in the long term, which ultimately diminishes clinical outcomes,” they reported. “ESI were associated with significantly less improvement at four years among all patients with spinal stenosis.”
Researchers say there was also evidence that surgery was more complicated in patients who had ESI. On average, surgery took about one-half hour longer in patients who received a steroid injection. They also spent about a day longer in the hospital. There was no evidence that receiving steroid injections helped patients avoid surgery.
“Despite the common treatment practice of incorporating one or more ESI in the initial non-operative management of patients with spinal stenosis, these results suggest that ESI is associated with worse outcome in the treatment of spinal stenosis,” Radcliff wrote.
Other recent studies have also questioned the value of epidural steroid injections. A study by Australian researchers found that steroid shots do little to relieve back pain caused by sciatica and should only be considered as a last resort.
Patients treated with steroid injections are also at increased risk of bone fractures, according to a study at Henry Ford Hospital in Detroit. Researchers there said the risk of a spinal fracture increases 29 percent with each steroid injection.
Henry Ford researchers also reported that women can suffer significant bone density loss in their hip after being treated with a single steroid injection for back pain.