Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?

Abstract

BACKGROUND CONTEXT:

Epidural corticosteroid injections are commonly used to treat back and leg pain associated with lumbar spinal stenosis. However, little is known about which patient characteristics may predict favorable responses.

PURPOSE:

The aim was to identify patient characteristics associated with benefits from epidural injections of corticosteroid with lidocaine versus epidural injections of lidocaine only for lumbar spinal stenosis symptoms.

STUDY DESIGN/SETTING:

This was a secondary analysis of Lumbar Epidural steroid injections for Spinal Stenosis randomized controlled trial data from 16 US clinical sites.

PATIENT SAMPLE:

Patients aged older than or equal to 50 years with moderate-to-severe leg pain and lumbar central spinal stenosis randomized to epidural injections of corticosteroids with lidocaine (n=200) or lidocaine only (n=200) were included.

OUTCOME MEASURES:

Primary outcomes were the Roland-Morris Disability Questionnaire (RMDQ) and 0 to 10 leg pain intensity ratings. Secondary outcomes included the Brief Pain Inventory Interference Scale and the Swiss Spinal Stenosis Questionnaire.

METHODS:

At baseline, clinicians rated severity of patient spinal stenosis, and patients completed predictor and outcome measures. Patients completed outcome measures again 3 and 6 (primary end point) weeks after randomization/initial injection. Analysis of covariance was used with treatment by covariate interactions to identify baseline predictors of greater benefit from corticosteroid+lidocaine versus lidocaine alone. We also identified nonspecific (independent of treatment) predictors of outcomes.

RESULTS:

Among 21 candidate predictors and six outcomes, only one baseline variable predicted greater benefit from corticosteroid+lidocaine versus lidocaine only at 3 or 6 weeks. Compared with patients who rated their health-related quality of life as high on the EQ-5D Index, patients who rated it as poor had greater improvement with corticosteroid than with lidocaine only in leg pain at 6 (but not 3) weeks (interaction coefficient=2.94; 95% confidence interval [CI]=0.11-5.76; p=.04) and in RMDQ disability scores at 3 (but not 6) weeks (interaction coefficient=4.77, 95% CI= -0.04 to 9.59; p = .05). Several baseline patient characteristics predicted outcomes regardless of treatment assignment.

CONCLUSIONS:

Among 21 baseline patient characteristics examined, none, including clinician-rated spinal stenosis severity, were consistent predictors of benefit from epidural injections of lidocaine+corticosteroid versus lidocaine only.

• Authors: Judith A Turner, Bryan A Comstock, Christopher J Standaert, Patrick J Heagerty, Jeffrey G Jarvik, Richard A Deyo, Ajay D Wasan, Srdjan S Nedeljkovic, Janna L Friedly
• Journal: The spine journal : official journal of the North American Spine Society (Spine J) Vol. 15 Issue 11 Pg. 2319-31 (Nov 01 2015) ISSN: 1878-1632 [Electronic] United States
• PMID: 26096484 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Adrenal Cortex Hormones

Topics

• Adrenal Cortex Hormones (administration & dosage, adverse effects, therapeutic use)
• Aged
• Aged, 80 and over
• Female
• Humans
• Injections, Epidural
• Male
• Middle Aged
• Pain Management (adverse effects, statistics & numerical data)
• Randomized Controlled Trials as Topic
• Spinal Stenosis (drug therapy, epidemiology)