Lumbar computed tomography (CT)-guided corticosteroid infiltration may effectively alleviate refractory low back pain associated with a number of conditions, including disk herniation, lumbar stenosis, and spondyloarthrosis, according to a retrospective study presented at the 2019 European League Against Rheumatism (EULAR) Congress, held June 12-15, in Madrid, Spain.
“Mechanical low back pain which is refractory to analgesic and rehabilitative treatment is an important cause of disability,” noted the researchers. “The primary objective of corticosteroid lumbar infiltration is to accelerate the recovery process and to avoid surgery. However, its use is not without controversy.”
The investigators retrospectively reviewed patient data from lumbar CT-guided corticosteroid infiltrations that were performed at a single center between 2012 and 2018 (n=445 patients; mean age, 58.6±14.8 years; n=482 procedures). Data examined in this analysis were epidemiologic variables, underlying pathologies, injection approach, type of corticosteroid used, efficacy at 1- and 3-month follow-ups, and occurrence of complications. These data were compared using a study in which the efficacy of lumbar CT-guided corticosteroid infiltration was examined based on indication, type of corticosteroid used, and injection approach. Between-group comparisons were performed.
In this cohort, lumbar CT-guided corticosteroid infiltrations were most commonly performed in traumatology (88.8%), and 4.8% of procedures were performed for rheumatology indications. Indications for the procedures included disk herniation (43.1%), lumbar spinal stenosis (36.4%), postoperative fibrosis (14.8%), spondyloarthrosis (2.7%), and other conditions (ie, listhesis, synovial cyst, and facet joint syndrome; 2.8%). The corticosteroids used in these procedures were dexamethasone (66.3%) and triamcinolone (33.7%). Approaches used for the procedure were posterior epidural access (27.1%), foraminal recess (17.9%), and lateral recess (55%).
A total of 68% and 63.2% of patients reported experiencing improvement at the 1- and 3-month follow-up independent of pathology, corticosteroid used, and approach for injection. A total of 21.3% of patients had persistent pain that required surgery, which was performed within the first year following infiltration for 66.9% of these patients.
The indication for performing the procedure had no impact on the clinical efficacy of the procedure, but foraminal and lateral recess approaches were associated with greater pain relief at 3 months compared with epidural approaches (P =.002). The use of triamcinolone vs dexamethasone was associated with greater improvements at the1- and 3-month follow-ups (P ≤.001).
Limitations of the study include the single-center design as well as the retrospective collection and assessment of the data.
“In this study, lumbar CT-guided [corticosteroid] infiltration in patients with refractory low back pain is an accessible, minimally invasive, safe and effective procedure in [the] long term,” concluded the study authors.
Calvo I, Ibarguengoitia O, Montero D, Vega L, María L, Ruiz ME, et al. Refractory low back pain and lumbar CT-guided steroid infiltration. Study of 582 procedures from the same center. Presented at: European League Against Rheumatism (EULAR) Congress 2019; June 12-15, 2019; Madrid, Spain. Abstract AB0911.