Skeletal Radiology

, Volume 39, Issue 7, pp 691–699

Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results

  • Joon Woo Lee
  • Jae Sung Myung
  • Kun Woo Park
  • Jin S. Yeom
  • Ki-Jeong Kim
  • Hyun-Jib Kim
  • Heung Sik Kang
Scientific Article

Abstract

Objective

To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors.

Materials and methods

All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation (aggravated, no change, slightly improved, much improved, no pain). In June 2009 telephone interviews were conducted, using formatted questions including the North American Spine Society (NASS) patient satisfaction scale. For short-term and long-term effects, age difference was evaluated by the Mann–Whitney U test, and gender, duration of symptoms, level of DLSS, spondylolisthesis, and previous operations were evaluated by Fisher’s exact test.

Results

Two hundred and sixteen patients (male:female = 75:141; mean age 69.2 years; range 48 ∼ 91 years) were included in the study. Improvements (slightly improved, much improved, no pain) were seen in 185 patients (85.6%) after an initial caudal ESI and in 189 patients (87.5%) after a series of caudal ESIs. Half of the patients (89/179, 49.8%) replied positively to the NASS patient satisfaction scale (1 or 2). There were no significant outcome predictors for either the short-term or the long-term responses.

Conclusion

Fluoroscopically guided caudal ESI was effective for the management of DLSS (especially central canal stenosis) with excellent short-term and good long-term results, without significant outcome predictors.

Keywords

Caudal epidural steroid injection Spine intervention Lumbar spine Spinal stenosis Steroid 

References

  1. 1.
    Spivak JM. Degenerative lumbar spinal stenosis. J Bone Joint Surg Am. 1998;80:1053–66.PubMedGoogle Scholar
  2. 2.
    Arbit E, Pannullo S. Lumbar stenosis: a clinical review. Clin Orthop. 2001;384:137–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Sirvanci M, Bhatia M, Ganiyusufoglu KA, Duran C, Tezer M, Ozturk C, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J. 2008;17:679–85.CrossRefPubMedGoogle Scholar
  4. 4.
    Postacchini F. Surgical management of lumbar spinal stenosis. Spine. 1999;24:1043–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Simotas AC, Dorey FJ, Hansraj KK, Cammisa F Jr. Nonoperative treatment for lumbar spinal stenosis. Clinical and outcome results and a 3-year survivorship analysis. Spine. 2000;25:197–203; discussion 203–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007;10:7–111.PubMedGoogle Scholar
  7. 7.
    Friedly J, Chan L, Deyo R. Increases in lumbosacral injections in the Medicare population: 1994 to 2001. Spine. 2007;32:1754–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Botwin K, Brown LA, Fishman M, Rao S. Fluoroscopically guided caudal epidural steroid injections in degenerative lumbar spine stenosis. Pain Physician. 2007;10:547–58.PubMedGoogle Scholar
  9. 9.
    Ciocon JO, Galindo-Ciocon D, Amaranath L, Galindo D. Caudal epidural blocks for elderly patients with lumbar canal stenosis. J Am Geriatr Soc. 1994;42:593–6.PubMedGoogle Scholar
  10. 10.
    Cuckler JM, Bernini PA, Wiesel SW, Booth RE Jr, Rothman RH, Pickens GT. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg Am. 1985;67:63–6.PubMedGoogle Scholar
  11. 11.
    Rosen CD, Kahanovitz N, Bernstein R, Viola K. A retrospective analysis of the efficacy of epidural steroid injections. Clin Orthop. 1988;228:270–2.PubMedGoogle Scholar
  12. 12.
    Abdi S, Datta S, Lucas LF. Role of epidural steroids in the management of chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician. 2005;8:127–43.PubMedGoogle Scholar
  13. 13.
    Barre L, Lutz GE, Southern D, Cooper G. Fluoroscopically guided caudal epidural steroid injections for lumbar spinal stenosis: a restrospective evaluation of long term efficacy. Pain Physician. 2004;7:187–93.PubMedGoogle Scholar
  14. 14.
    Manchikanti L, Cash KA, McManus CD, Pampati V, Abdi S. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 4—Spinal stenosis. Pain Physician. 2008;11:833–48.PubMedGoogle Scholar
  15. 15.
    Boswell MV, Shah RV, Everett CR, Sehgal N, McKenzie Brown AM, Abdi S, et al. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines. Pain Physician. 2005;8:1–47.PubMedGoogle Scholar
  16. 16.
    Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990;34:335–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Kantrowitz F, Robinson DR, McGuire MB, Levine L. Corticosteroids inhibit prostaglandin production by rheumatoid synovia. Nature. 1975;258:737–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Delport EG, Cucuzzella AR, Marley JK, Pruitt CM, Fisher JR. Treatment of lumbar spinal stenosis with epidural steroid injections: a retrospective outcome study. Arch Phys Med Rehabil. 2004;85:479–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Southern D, Lutz GE, Cooper G, Barre L. Are fluoroscopic caudal epidural steroid injections effective for managing chronic low back pain? Pain Physician. 2003;6:167–72.PubMedGoogle Scholar
  20. 20.
    Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli JT, Freeman ED, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil. 2002;81:898–905.CrossRefPubMedGoogle Scholar
  21. 21.
    Fukusaki M, Kobayashi I, Hara T, Sumikawa K. Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain. 1998;14:148–51.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2009

Authors and Affiliations

  • Joon Woo Lee
    • 1
  • Jae Sung Myung
    • 1
  • Kun Woo Park
    • 2
  • Jin S. Yeom
    • 2
  • Ki-Jeong Kim
    • 3
  • Hyun-Jib Kim
    • 3
  • Heung Sik Kang
    • 1
  1. 1.Department of RadiologySeoul National University Bundang HospitalSeong NamKorea
  2. 2.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSeong NamKorea
  3. 3.Department of NeurosurgerySeoul National University Bundang HospitalSeong NamKorea

Personalised recommendations