Epidural Steroid For Lumbar Spinal Stenosis Pros and Cons by Dr. Tony Mork
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Today, I want to discuss a compelling article I recently came across in one of our trade journals. The article delves into the use of epidural steroids for the treatment of lumbar spinal stenosis. But before we dive into the details, let's have a quick overview of spinal stenosis.
Spinal stenosis refers to the narrowing of the hollow tubes or canals through which the spinal cord and nerves pass. Think of it like a buildup of calcium deposits in water pipes, occupying valuable space that should be available for the nerves within the spine.
Now, let's talk about epidural steroid injections (ESIs). You may have heard about these injections in the context of treating back pain, and I'll show you how they work on a model. In the spine, we have the vertebral discs in the front, the spinous processes in the back, and the spinal cord in the center. The space around the spinal cord is the epidural space, where we administer the steroid injection. Using fluoroscopic X-rays, we inject the steroid into the epidural space to bathe the contents of the spinal canal and alleviate inflammation and pain.
In a recent article from the American Academy of Orthopedic Surgeons, Dr. Bobby Kalantar of Georgetown University made an important point—epidural steroids are not meant to replace surgery, as surgery can be highly beneficial. ESIs are a non-surgical option to address lumbar spinal stenosis.
Dr. Kalantar highlighted the natural history of lumbar spinal stenosis, noting that untreated patients showed varied outcomes over a period of around four years. 70% remained unchanged, 15% improved, and 15% worsened, for no apparent reason. This natural history underscores the need for effective treatments.
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