Abstract 3: Fluoroscopically guided caudal epidural steroid injections for lumbar spinal stenosis: An evaluation of long-term efficacy

Abstract

Objective: To assess the efficacy of fluoroscopically guided caudal epidural steroid injections (ESIs) in the management of lumbar spinal stenosis. Design: Retrospective chart review and follow-up study. Setting: Academic-affiliated outpatient physiatry practice. Participants: Patients with low back and/or leg pain of at least 3 months in duration with clinical and radiographic evidence of moderate to severe lumbar spinal stenosis who received caudal ES’s between 1995 and 2002. Patients who had undergone prior lumbar spinal surgery were excluded. Intervention: Fluoroscopically guided caudal ESIs. Main Outcome Measures: Visual Numeric Scale (VNS), Roland-Morris Disability Questionnaire (RMDQ), North American Spine Society Patient Satisfaction Index (PSI), and subsequent surgery. Results: Of 3153 charts reviewed, 95 patients met inclusion criterion. 79 (83%) completed the follow-up questionnaire by mail or telephone interview. The mean patient age was 70 years, mean duration of symptoms was 39 months, and average follow-up time was 31 months. Patients underwent an average of 1.5 caudal ESIs. 9 patients subsequently underwent surgery; 1 had an intradiskal electrothermal therapy procedure. A VNS improvement of 50% or greater was seen in 37% of patients. With respect to patient satisfaction, 44% reported that the procedure either fully met their expectations or that they would undergo it again for the same outcome. A functional improvement of 2 points or greater was seen on the RMDQ in 40% of patients. The concurrent presence of degenerative spondylolisthesis was the only variable that had a significant positive correlation with successful outcomes ( P<.003). Conclusions: Caudally placed, fluoroscopically guided ESIs offer a safe, minimally invasive option for managing pain caused by lumbar spinal stenosis. Many patients in this study derived long-term benefit from a single caudal ESI. The concurrent presence of degenerative spondylolisthesis appears to be a positive prognostic factor for successful response.