New study may change the way spinal stenosis is treated in the future

A recent study published in the New England Journal of Medicine and discussed in the New York Times, found that patients who had a standard steroid injection for spinal stenosis did not decrease pain or improve function after six weeks any more than patients who received an anesthetic injection alone.

Spinal stenosis occurs when space within the spine compresses and puts pressure on nerves, causing pain and loss of feeling in the back and/or legs. Research shows that two-thirds of people over the age of sixty have some degree of spinal stenosis.

Sean MacKenzie, MD, a Physical Medicine and Rehabilitation specialist with Rockford Orthopedic Spine Center who was not involved with the study, said, “Injections for spinal stenosis provide modest benefits at best. In general, they are only a temporary solution.”

Dr. MacKenzie also pointed out that we are still learning about spinal stenosis treatment and speculated that hypothetically the mere injection of a needle into the epidural space could be providing the benefit to patients, similar to the benefit of Trigger Point Dry Needling.

The researchers involved in the study hope that their findings will help physicians and patients to make better decisions about when stenosis injections are appropriate and when they are clearly not.

It should be noted that experts said patients experienced greater benefits than traditional placebos, so both treatments do work, but the long-lasting benefits are not necessarily supported, which could mean physicians would hesitate before repeating a steroid injection for spinal stenosis.

“This is just one study,” MacKenzie said, “and [it] needs to be replicated on a larger level before any real conclusions can be drawn. This will give us pause to think about these injections, but…to switch to just Lidocaine instead of steroids at this point would be tantamount to experimental medicine.”

Traditionally, injections are only used if inflammation is identified as the source of the problem and the patient has not experienced any loss of motion or weakness.  Once that happens, surgery is often considered.