Abstract
BACKGROUND AND PURPOSE: Epidural steroid injections may offer little-to-no short-term benefit in the overall population of patients with symptomatic spinal stenosis compared with lidocaine alone. We investigated whether imaging could identify subgroups of patients who might benefit most.
MATERIALS AND METHODS: A secondary analysis of the Lumbar Epidural Steroid Injections for Spinal Stenosis prospective, double-blind trial was performed, and patients were randomized to receive an epidural injection of lidocaine with or without corticosteroids. Patients (n = 350) were evaluated for qualitative and quantitative MR imaging or CT measures of lumbar spinal stenosis. The primary clinical end points were the Roland-Morris Disability Questionnaire and the leg pain numeric rating scale at 3 weeks following injection. ANCOVA was used to assess the significance of interaction terms between imaging measures of spinal stenosis and injectate type on clinical improvement.
RESULTS: There was no difference in the improvement of disability or leg pain scores at 3 weeks between patients injected with epidural lidocaine alone compared with corticosteroid and lidocaine when accounting for the primary imaging measures of qualitative spinal stenosis assessment (interaction coefficients for disability score, −0.1; 95% CI, −1.3 to 1.2; P = .90; and for the leg pain score, 0.1; 95% CI, −0.6 to 0.8; P = .81) or the quantitative minimum thecal sac cross-sectional area (interaction coefficients for disability score, 0.01; 95% CI, −0.01 to 0.03; P = .40; and for the leg pain score, 0.01; 95% CI, −0.01 to 0.03; P = .33).
CONCLUSIONS: Imaging measures of spinal stenosis are not associated with differential clinical responses following epidural corticosteroid injection.
ABBREVIATIONS:
- AP
- anteroposterior
- ESI
- epidural steroid injection
- ML
- mediolateral
- NRS
- numeric rating scale
- RDQ
- Roland-Morris Disability Questionnaire
Footnotes
Disclosures: Jeffrey G. Jarvik—RELATED: Grant: Agency for Healthcare Research and Quality, Comments: federal grant*; Support For Travel to Meetings for the Study or Other Purposes: Agency for Healthcare Research and Quality*; Fees for Participation in Review Activities Such as Data Monitoring Boards, Statistical Analysis, Endpoint Committees, and the Like: Agency for Healthcare Research and Quality*; Payment for Writing or Reviewing the Manuscript: Agency for Healthcare Research and Quality*; UNRELATED: Consultancy: UpToDate, Comments: section editor/consultant; Grants/Grants Pending: National Institutes of Health, Patient-Centered Outcomes Research Institute*; Payment for Lectures Including Service on Speakers Bureaus: Radiological Society of North America, Comments: Clinical Trials Methodology Workshop faculty member; Royalties: UpToDate, Springer Publishing; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Association of University Radiologists (AUR) and General Electric (GE), Comments: GE-AUR Radiology Research Academic Fellowship annual retreat. Emin Aghayev—UNRELATED: Employment: Schulthess Clinic Zurich, Swiss Federal Government, University of Bern. Ella R. Jarvik—RELATED: Grant: Agency for Healthcare Research and Quality, Comments: 1R01HS01922201.* Andrew L. Avins—RELATED: Grant: Agency for Healthcare Research and Quality, Comments: as part of the Agency for Healthcare Research and Quality–funded multicenter clinical trial.* Jason M. Schwalb—RELATED: Grant: Agency for Healthcare Research and Quality, Comments: 1R01HS019222*; UNRELATED: Other: Blue Cross Blue Shield of Michigan, Comments: salary support for my role as Co-Director of the Michigan Spine Surgery Improvement Collaborative.* Christopher J. Standaert—RELATED: Grant: Agency for Healthcare Research and Quality, Patient-Centered Outcomes Research Institute.* David R. Nerenz—RELATED: Grant: Agency for Healthcare Research and Quality, Comments: standard research grant with funds used to cover the cost of conducting the study at our institution*; UNRELATED: Board Membership: Medicare Payment Advisory Commission, Comments: The Commission work involves the full range of Medicare payment issues. I served as a Medicare Payment Advisory Commission commissioner from 2012 to 2018; Employment: Henry Ford Health System, Comments: I was a full-time employee of the Henry Ford Health System during the entire time covered by this disclosure. Thiru Annaswamy—RELATED: Grant: Agency for Healthcare Research and Quality, Comments: The LESS study was funded by the Agency for Healthcare Research and Quality*; UNRELATED: Employment: federal government, Comments: I am a full-time employed physician at the VA. Zoya Bauer—RELATED: Grant: Agency for Healthcare Research and Quality.* Srdjan S. Nedeljkovic—RELATED: Grant: Brigham and Women's Hospital.* Janna L. Friedly—RELATED: Grant: Agency for Healthcare Research and Quality, Patient-Centered Outcomes Research Institute.* Patrick J. Heagerty—RELATED: Grant: National Institutes of Health.* *Money paid to the institution.
This work was supported by the Agency for Healthcare Research and Quality (grants 1R01HS019222-01 and 1R01HS022972-01) and the Patient-Centered Outcomes Research Institute (contract CE-12-11-4469).
Paper previously presented at: American Society of Neuroradiology Annual Meeting and the Foundation of the ASNR Symposium, April 25–30, 2015; Chicago, Illinois. “Qualitative Assessment of Lumbar Spinal Stenosis by CT and MRI: Stenosis Severity Does Not Predict Response to Epidural Glucocorticoid Injections.”
- © 2019 by American Journal of Neuroradiology
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