Value of the Magnetic Resonance Imaging in Patients With Painful Lumbar Spinal Stenosis (LSS) Undergoing Lumbar Epidural Steroid Injections

Kapural, Leonardo; Mekhail, Nagy; Bena, James; McLain, Robert F.; Tetzlaff, John; Kapural, Miranda; Mekhail, Mena; Polk, Sam L.

doi:10.1097/ajp.0b013e3180e00c34

Cited by 29 publications

(23 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among individuals with spinal stenosis, a direct correlation has been found between the severity of pathology and response to treatment. 138,224 In a subgroup analysis of a randomized, placebo-controlled study by Ghahreman and Bogduk 170 performed in patients with herniated disk, the authors noted an inverse relationship between the degree of nerve root compression on magnetic resonance imaging and the likelihood of a successful outcome. This association was hypothesized to stem from the fact that those with low-grade compression experienced predominantly inflammatory-mediated pain, as opposed to pain due to mechanical compression that is more refractory to treatment.…”

Section: Factors Associated With Esi Resultsmentioning

confidence: 99%

Epidural Steroids

Cohen¹,

Bicket

Jamison

et al. 2013

Regional Anesthesia and Pain Medicine

300

114

View full text Add to dashboard Cite

Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. Overall, more than half of controlled studies have demonstrated positive findings, suggesting a modest effect size lasting less than 3 months in well-selected individuals. Transforaminal injections are more likely to yield positive results than interlaminar or caudal injections, and subgroup analyses indicate a slightly greater likelihood for a positive response for lumbar herniated disk, compared with spinal stenosis or axial spinal pain. Other factors that may increase the likelihood of a positive outcome in clinical trials include the use of a nonepidural (eg, intramuscular) control group, higher volumes in the treatment group, and the use of depo-steroid. Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.

show abstract

Section: Factors Associated With Esi Resultsmentioning

confidence: 99%

Epidural Steroids

Cohen¹,

Bicket

Jamison

et al. 2013

Regional Anesthesia and Pain Medicine

300

114

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6][7] Although the prevalence of lumbar spinal stenosis is unknown, there has been a steady, dramatic rise in spine surgery rates over recent decades, [8][9][10] with spinal stenosis being the most common diagnosis associated with spinal surgery in adults over 60 years of age. [9][10][11] Physical therapy is commonly recommended for patients with mild to moderate LSS, while patients with severe LSS typically undergo a trial of conservative treatment before surgery is proposed.…”

Section: Introductionmentioning

confidence: 99%

Physical Therapy Interventions for Degenerative Lumbar Spinal Stenosis: A Systematic Review

et al. 2013

View full text Add to dashboard Cite

show abstract

“…A negative correlation between response to IT and the degree of stenosis and the number of affected levels was demonstrated by Kapural et al 37 Patients with one or more severely stenotic lumbar levels did not improve after IT. Thus the authors suggest offering other treatment options than IT to this subgroup.…”

Section: Lumbar Spinal Stenosismentioning

confidence: 85%

Ten-Day Response to CT-Guided Spinal Infiltration Therapy in More Than a Thousand Patients

Brändle

Stienen

Neff

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

show abstract

Value of the Magnetic Resonance Imaging in Patients With Painful Lumbar Spinal Stenosis (LSS) Undergoing Lumbar Epidural Steroid Injections

Abstract: The improvement in VAS pain scores after LES injections correlated well with the changes in the SPI except in those patients classified on MRI as severe LSS and more than 3 lumbar levels affected. That patient group is unlikely to benefit from LES injections.

Cited by 29 publications

References 19 publications

Epidural Steroids

Epidural Steroids

Physical Therapy Interventions for Degenerative Lumbar Spinal Stenosis: A Systematic Review

Ten-Day Response to CT-Guided Spinal Infiltration Therapy in More Than a Thousand Patients

Contact Info

Product

Resources

About