Effect of fluoroscopically guided caudal epidural steroid injection in degenerative lumbar spinal stenosis–A randomized controlled trial

Introduction/Background Degenerative lumbar spinal stenosis (DLSS) is a common source of pain and disability in the elderly population. Epidural steroid injections are often used to treat lumbosacral radiculopathy in DLSS. There is paucity of clinical trials comparing caudal epidural steroid injections plus local anaesthetics with conservative treatment. Moderate and high-quality evidence for nonoperative treatment is lacking and thus prohibits recommendations for guiding clinical practice. So, the aim of this study was to compare the effects of conservative treatment (physical therapy) and caudal epidural steroid injection with physical therapy in patients of DLSS (grade A and B). Material and method An Open Label, Parallel randomized controlled trial was conducted from January 2016–August 2017 and patients fulfilling the inclusion criteria were enrolled after written informed consent. The Trial was registered under the Clinical Trial Registry of India (CTRI). Patients were randomized in two groups–32 in Intervention Group A (caudal epidural steroid injection with physical therapy) and 32 in Control Group B (physical therapy only) with concealed allocation method. The outcome was assessed by Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), standing tolerance test and walking tolerance test at 3, 6, 12 and 24 weeks. Results Significant improvement in NPRS, ODI and standing tolerance test was observed at 3, 6 and 12 weeks (Group A > > Group B). Equivocal effect in NPRS and ODI was seen at 24 weeks (Group A ∼ Group B). Improvement in mean claudication distance was seen at each follow up from baseline (Group A > > Group B). The probability of improvement in intervention group (A) was more than in control group (B). Conclusion Epidural steroid administration improved pain, physical ability and claudication distance (> 200 meters) at 12 weeks aiding an early return to routine activities. Physical therapy also shows clinical improvement in patients of DLSS and can be an appropriate treatment modality.