Older individuals with symptomatic lumbar stenosis who were given lumbar epidural steroid injections (ESIs) were found to have improved pain scores and physical function 1 month after the intervention, using the Short Physical Performance Battery (SPPB), according to a study published in Current Pain and Headache Reports.
Elderly patients with degenerative spinal changes often have severe low back pain and radicular leg pain, both with functional impact. Although pain medications and spinal surgery remain therapeutic options, their use is limited in this population because of adverse effects and complications, respectively. Another option is the use of ESIs, but evidence of their efficacy in this patient population is lacking. Investigators aimed to explore objective assessments of pain and physical capacity in patients with lumbar stenosis who received ESIs compared with those who were treated with standard medications.
For this prospective observational study, a total of 16 patients >65 years (range, 68-83 years) with symptomatic lumbar stenosis were enrolled. Study participants were offered the choice to be treated with lumbar ESI (dexamethasone 10 mg) or medication (tramadol and gabapentin). There were 11 participants (mean age, 75.0 years; 81.8% men) who opted for ESI and 5 (mean age, 76.6 years; 40.0% men) who chose treatment with medication.
Primary outcomes evaluated at baseline and after 1 month included pain intensity evaluated with a self-reported 0 to 10 numeric rating scale, the Short Physical Performance Battery (SPPB; on a 0-12 scale), and SPPB component scores. Secondary outcomes were adverse effect and complication rates.
Patients who received ESI vs medication were found to have higher pain scores at baseline (7.9 vs 5.4, respectively; P =.03). At the 1-month follow-up, participants in the injection group had improvements in pain scores and overall SPPB scores (P =.001 for both), as well as in SPPB component scores, including balance (P =.008), chair stand time (P =.047), and 4-m walk test (P =.001). No comparable improvements were seen for any of the primary outcomes in the medication group. No adverse effects or complications were noted in either treatment group.
Study limitations include a small sample size, a lack of randomization, and significant baseline pain score differences between groups.
“[T]he SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic,” noted the study authors.
Przkora R, Kinsky MP, Fisher SR, et al. Functional improvements utilizing the Short Physical Performance Battery (SPPB) in the elderly after epidural steroid injections. Curr Pain Headache Rep. 2019;23(14):1-7. doi:10.1007/s11916-019-0748-2