Steroids Used to Treat Spinal Stenosis May Not Be Effective Afterall

Spinal Stenosis: A Painful and Life-Altering Condition

I’ve had the good fortune to know Bonnie Merenstein for over 40 years, who was recently featured in a NYT article outlining the lack of effectiveness of a common back and leg pain treatment.  That pain derives from what is known as spinal stenosis, or the narrowing of the open spaces in your spine, leading to pain in the spinal cord and nerves.  Unfortunately, spinal stenosis is not just associated with pain–it’s also associated with a host of other side effects including numbness, muscle weakness and loss of bladder control.  Needless to say, sufferers typically want a remedy to help ease their pain and the embarrassment linked to the other side effects of the condition.  Bonnie suffers from spinal stenosis and participated in a new study looking at the effectiveness of injectable steroids combined with a local anesthetic, a common treatment for the condition.  The treatment is expensive but widely used by doctors to treat their patients with spinal stenosis, however it may not be that effective after all.

Common Back and Leg Treatment May be Ineffective

The study was the largest randomized trial evaluating the most common treatment for spinal stenosis–combined steroid and local anesthetic injected into the patient.  Although this is the most common treatment, it also costs hundreds of millions of dollars each year in the U.S.  Study results say we should stop spending so much money on this treatment because it’s no better than a simpler treatment–local anesthetic alone.  The study included 400 patients at 16 different treatment sites, some of which received the combined treatment and some of which received just the local anesthetic.  The results showed that the patients who received the combined dosage had no better function or pain levels than the patients who only received local anesthetic.  These results led the study authors to conclude that the risks of the combined injection outweigh the benefits, since it gives no greater benefit than the local anesthetic alone.

Steroid Injections Offered When Physical Therapy and Anti-Inflammatory Meds Fail

Doctors may often recommend physical therapy or anti-inflammatory medication for patients suffering from spinal stenosis.  However, when these remedies fail, patients may be given the combination injection.  The study results clearly speak against giving multiple injections, but this may still leave patients in a lurch.  Specifically, there aren’t may treatments for spinal stenosis, and with a rapidly aging population, this is a problem.  There were also some questions left unanswered by the study because of some weaknesses.  For example, the study group did not include patients with different types of stenosis–some of which are more treatable with local anesthetic.  And still other patients say that their pain is effectively treated with steroid injections, leading some doctors to say that it depends on the patient as to how effective a treatment will be, but remains unclear which mechanisms effect how a patient will respond to a particular treatment.