SPINAL STENOSIS

COMPARISON OF THREE DOSES WITH SINGLE DOSE OF EPIDURAL STEROID INJECTION WITH SINGLE DOSE OF LUMBAR RADICULAR PAIN

Abstract

Introduction: Spinal stenosis causing lower back pain and radiculopathy and
it is the most common cause of patient admission at Spine centre as compared to other spine
pathologies. Most common complaint in the Spine outpatient department or hospital admissions
Different modalities have been applied with time for its management. Among them Epidural
steroid injection is also. Objectives: “To Compare three doses of epidural steroid injection with
single dose of epidural steroid injection for Lumbar Radicular pain in spinal stenosis patients.”
Study Design: Prospective study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan.
Period: Jan 2016 to Dec 2016. Materials and Methods: 95 patients with lumbar radicular pain
due to spinal stenosis were randomly allocated into 2 groups. In Group A, 42 patients were given
120 mg of Depo-medrol (40 mg per day for 3 days) along with local anesthesia and in group B,
43 patients were given 40 mg of Depo-medrol with local anesthesia as a single dose. Both Group
A and Group B were matched in terms of age and gender. On visual analogue scoring, pain was
assessed after 2 weeks, 3 months and 6 months. Results: In Group A (3 doses of depomedrol)
VAS improvement at 2 weeks, 3 months and 6 months were more than group B (single dose of
depomedrol) which was statistically significant (p < 0.05). There were no major complications
like epidural hematoma or abscess formation in both groups. The overall minor complications
like flushing, transient hyperglycemia and headache due to CSF hypotension were more in
Group A than Group B but statistics shows no significant difference. All the adverse events
resolved within few days without any significant morbidity and subsequent hospitalizations.
Conclusion: Epidural steroid injection is excellent modality in the treatment of lower back pain
with radiculopathy. Moreover 3 doses have greater effect in relieving pain as compared to single
dose. There is no increase risk of complications by increasing dose.