The Efficacy and Factors Associated With Epidural Injections in the Management of Lumbar Spinal Stenosis and in Terms of Delaying Laminectomy: A Retrospective Study.

Abstract

Background: Lumbar epidural injections have been studied as symptomatic treatments for lumbar spinal stenosis (LSS). However, results about their efficacy have been controversial, and data regarding their use is scarce. Our purpose in this article is to study the efficacy of epidural injections in the management of pain and disability in patients suffering from spinal stenosis, to study the factors which can affect their efficacy, and to discuss whether they could replace surgery or not.

Methods: A retrospective study between 2021 and 2022 took place in a Pain Clinic located in Notre-Dame des Secours University Hospital-Lebanon. The study was done on 128 patients, of whom 18 were excluded because they underwent laminectomy before taking the transforaminal lumbar epidural injections. Medical records were viewed. Outcome measures were checked before and after epidural injections using the numerical pain scale and the Oswestry Disability Index (ODI) scale. Physical activity was assessed with a physical activity index.

Results: Back pain scores (9.46 ± 1.07 vs. 3.91 ± 3.13; P < 0.001), leg pain scores (9.31 ± 1.41 vs. 3.75 ± 3.17; P < 0.001), and ODI scores (27.45 ± 8.97 vs. 9.40 ± 9.42; P < 0.001) decreased after the injection compared to before it. A higher physical activity index was significantly associated with a decrease in back pain, leg pain, and ODI scores after epidural injection. In 57.8% of the patients, epidural injections were sufficient for pain management without the need for surgery.

Conclusion: Epidural injections are effective in the management of back and leg pain associated with LSS and in improving patients' disability. Engaging in activities like walking and swimming is associated with better results. In some cases, epidural injections may replace surgery.