F A Perez1, S Quinet2, J G Jarvik1,3,4,5, Q T Nguyen1,6, E Aghayev7, D Jitjai8, W D Hwang9, E R Jarvik10, S S Nedeljkovic11, A L Avins12, J M Schwalb13, F E Diehn14, C J Standaert15, D R Nerenz13, T Annaswamy16, Z Bauer17, D Haynor1, P J Heagerty3,18, J L Friedly19,20. 1. From the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.). 2. Department of Radiology (S.Q.), College of Wisconsin, Milwaukee, Wisconsin. 3. Comparative Effectiveness, Cost and Outcomes Research Center (J.G.J., P.J.H., J.L.F.). 4. Departments of Neurological Surgery (J.G.J.). 5. Health Services (J.G.J.). 6. Orthopedics and Sports Medicine (Q.T.N.). 7. Spinal Centre Division (E.A.), Schulthess Klinik, Zurich, Switzerland. 8. Oregon Health Sciences University (D.J.) Portland, Oregon. 9. TRA Medical Imaging (W.D.H.), Tacoma, Washington. 10. University of Washington Medicine (E.R.J.), Seattle, Washington. 11. Department of Anesthesiology, Perioperative and Pain Medicine and Spine Unit (S.S.N.), Harvard Vanguard Medical Associates, Brigham and Women's Hospital, Boston, Massachusetts. 12. Division of Research (A.L.A.), Kaiser Permanente Northern California, Oakland, California. 13. Department of Neurosurgery (J.M.S., D.R.N.), Henry Ford Medical Group, Detroit, Michigan. 14. Department of Radiology (F.E.D.), Mayo Clinic, Rochester, Minnesota. 15. Department of Physical Medicine and Rehabilitation (C.J.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 16. Department of Physical Medicine and Rehabilitation (T.A.), VA North Texas Healthcare System, Dallas, Texas. 17. Cancer and Blood Disorders Center (Z.B.), Seattle Children's Research Institute, Seattle, Washington. 18. Biostatistics (P.J.H.). 19. Comparative Effectiveness, Cost and Outcomes Research Center (J.G.J., P.J.H., J.L.F.) friedlyj@uw.edu. 20. Rehabilitation Medicine (J.L.F.), University of Washington, Seattle, Washington.
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.
RCT Entities:
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.
Authors: Richard A Deyo; Darryl T Gray; William Kreuter; Sohail Mirza; Brook I Martin Journal: Spine (Phila Pa 1976) Date: 2005-06-15 Impact factor: 3.468
Authors: Salahadin Abdi; Sukdeb Datta; Andrea M Trescot; David M Schultz; Rajive Adlaka; Sairam L Atluri; Howard S Smith; Laxmaiah Manchikanti Journal: Pain Physician Date: 2007-01 Impact factor: 4.965