Effectiveness of intradiscal steroid injection for spinal stenosis: a retrospective cohort study in South Korea.

Abstract

A retrospective cohort study. This study aimed to evaluate the efficacy of intradiscal steroid injection (ISI) in managing patients with spinal stenosis. ISI has shown effectiveness in relieving lower back pain in patients with degenerative disc disease. However, its potential utility in managing the symptoms of spinal stenosis remains unexplored. This study included 260 patients with spinal stenosis who complained of lower back pain and radiating pain in the lower extremities. During the ISI, a mixture of 1 mL of dexamethasone 5 mg and 1 mL of ropivacaine 0.2% was administered. Pain levels were assessed at weeks 2 and 6 after ISI using the Visual Analog Scale (VAS) for back and leg pain. Patients requiring surgery within a year because of persistent or worsening symptoms were analyzed, and pain score changes between the surgical and nonsurgical groups were compared. ISI significantly reduced the initial back pain VAS score (8.85) and leg pain VAS score (8.91) at weeks 2 (back pain=4.58; p<0.001, leg pain=4.42; p<0.001) and 6 (back pain=4.79; p<0.001, leg pain=4.70; p<0.001). A total of 228 patients (87.7%) showed improvement of initial symptoms without the need for surgery 1 year after ISI. The surgical and nonsurgical groups showed improvement in leg and back pain VAS scores 2 weeks after ISI. However, in the surgical group, a significant trend was noted toward worsening back and leg pain VAS score at week 6 after ISI. ISI effectively provided temporary pain relief for patients with lumbar spinal stenosis. The majority of patients, up to 1 year later, only necessitate conservative management of their symptoms and do not require surgery. In particular, if the improvement in pain persists up to 6 weeks after the ISI, surgical intervention may be delayed in favor of more conservative treatments.