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Epidural Steroid Injections for Management of Degenerative Spondylolisthesis
Epidural Steroid Injections for Management of Degenerative Spondylolisthesis
- Source :
- Journal of Bone and Joint Surgery. 102:1297-1304
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Background Although epidural steroid injection (ESI) may provide pain relief for patients with degenerative spondylolisthesis in treatment regimens of up to 4 months, it remains unclear whether ESI affects crossover from nonoperative to operative management. Methods This retrospective cohort study analyzed 2 groups of surgical candidates with degenerative spondylolisthesis: those who received ESI within 3 months after enrollment (ESI group) and those who did not (no-ESI group). Annual outcomes following enrollment were assessed within operative and nonoperative groups (patients who initially chose or were assigned to surgery or nonoperative treatment) by using longitudinal mixed-effect models with a random subject intercept term accounting for correlations between repeated measurements. Treatment comparisons were performed at follow-up intervals. Area-under-the-curve analysis for all time points assessed the global significance of treatment. Results The study included 192 patients in the no-ESI group and 74 in the ESI group. The no-ESI group had greater baseline Short Form-36 (SF-36) Bodily Pain scores (median, 35 versus 32) and self-reported preference for surgery (38% versus 11%). There were no differences in surgical rates within 4 years after enrollment between the no-ESI and ESI groups (61% versus 62%). The surgical ESI and no-ESI groups also showed no differences in changes in patient-reported outcomes at any follow-up interval or in the 4-year average. Compared with the nonoperative ESI group, the nonoperative no-ESI group showed greater improvements in SF-36 scores for Bodily Pain (p = 0.004) and Physical Function (p = 0.005) at 4 years, Bodily Pain at 1 year (p = 0.002) and 3 years (p = 0.005), and Physical Function at 1 year (p = 0.030) and 2 years (p = 0.002). Of the patients who were initially treated nonsurgically, those who received ESI and those who did not receive ESI did not differ with regard to surgical crossover rates. The rates of crossover to nonoperative treatment by patients who initially chose or were assigned to surgery also did not differ between the ESI and no-ESI groups. Conclusions There was no relationship between ESI and improved clinical outcomes over a 4-year study period for patients who chose or were assigned to receive surgery for degenerative spondylolisthesis. In the nonsurgical group, ESI was associated with inferior pain reduction through 3 years, although this was confounded by greater baseline pain. ESI showed little relationship with surgical crossover. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
- Subjects :
- Male
inorganic chemicals
medicine.medical_specialty
medicine.medical_treatment
Injections, Epidural
Lumbar vertebrae
law.invention
03 medical and health sciences
Spinal Stenosis
0302 clinical medicine
Randomized controlled trial
law
medicine
Humans
Orthopedics and Sports Medicine
Glucocorticoids
Aged
Retrospective Studies
030222 orthopedics
Lumbar Vertebrae
Epidural steroid
Epidural steroid injection
business.industry
organic chemicals
Laminectomy
technology, industry, and agriculture
Retrospective cohort study
General Medicine
Middle Aged
Degenerative spondylolisthesis
Surgery
Treatment Outcome
medicine.anatomical_structure
Female
lipids (amino acids, peptides, and proteins)
Observational study
Spondylolisthesis
business
Low Back Pain
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15351386 and 00219355
- Volume :
- 102
- Database :
- OpenAIRE
- Journal :
- Journal of Bone and Joint Surgery
- Accession number :
- edsair.doi.dedup.....b109d096f483cd8fa272046413260658
- Full Text :
- https://doi.org/10.2106/jbjs.19.00596