Lumbar spinal stenosis: methods of treatment with emphasis on epidural steroid injections

Background and Purpose: The aim of the study was to compare two techniques of steroid application into epidural space to patients with lumbar spinal stenosis (LSS), a chronic degenerative spine disorder. Patients and Methods: Sixty LSS patients have been distributed into 2 groups: “BLIND” (n=30, interlaminar epidural steroid injection without RTG control) and “RTG” (n=30, transforaminal epidural injection with RTG control). All patients have received 80 mg of triamcinolon (Kenalog) into epidural space on L4/L5 level, together with 0,5% lidocain (patients in RTG group 3 ml and those in BLIND group 10 ml) in 3 week intervals. They were asked to describe the pain using visual analogue scales (VAS) at the beginning of treatment (VAS-0), after the first (VAS-1), the second (VAS-2) and the third epidural injection (VAS-3). The differences between groups were shown using t-test (age) and c2-test (gender). Medians of VAS scores were statistically described using non parametrial methods. P<0.05 was considered as a statistically significant. Results: There is no statistical difference among patients regarding to age (P=0.93), gender (P=0.12) and VAS-0 score before the first injection (P=0.27). There is a statistically significant reduction of pain in relation to VAS-0 in both groups (P<0.001). Both groups do not statistically differ when it comes to their effectiveness in regards to VAS scores. Conclusions: We did not find any statistical difference in postinterventional VAS scores among two groups of patients. Choice of technique depends on the experience of the anesthesiologist, as well as on the local technical possibilities (availibility of RTG devices)