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Research ArticleSpine
Open Access

Lumbar Spinal Stenosis Severity by CT or MRI Does Not Predict Response to Epidural Corticosteroid versus Lidocaine Injections

F.A. Perez, S. Quinet, J.G. Jarvik, Q.T. Nguyen, E. Aghayev, D. Jitjai, W.D. Hwang, E.R. Jarvik, S.S. Nedeljkovic, A.L. Avins, J.M. Schwalb, F.E. Diehn, C.J. Standaert, D.R. Nerenz, T. Annaswamy, Z. Bauer, D. Haynor, P.J. Heagerty and J.L. Friedly
American Journal of Neuroradiology May 2019, 40 (5) 908-915; DOI: https://doi.org/10.3174/ajnr.A6050
F.A. Perez
aFrom the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.)
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S. Quinet
hDepartment of Radiology (S.Q.), College of Wisconsin, Milwaukee, Wisconsin
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J.G. Jarvik
aFrom the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.)
bComparative Effectiveness, Cost and Outcomes Research Center (J.G.J., P.J.H., J.L.F.)
cDepartments of Neurological Surgery (J.G.J.)
dHealth Services (J.G.J.)
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Q.T. Nguyen
aFrom the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.)
eOrthopedics and Sports Medicine (Q.T.N.)
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E. Aghayev
iSpinal Centre Division (E.A.), Schulthess Klinik, Zurich, Switzerland
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D. Jitjai
jOregon Health Sciences University (D.J.) Portland, Oregon
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W.D. Hwang
kTRA Medical Imaging (W.D.H.), Tacoma, Washington
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E.R. Jarvik
lUniversity of Washington Medicine (E.R.J.), Seattle, Washington
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S.S. Nedeljkovic
mDepartment of Anesthesiology, Perioperative and Pain Medicine and Spine Unit (S.S.N.), Harvard Vanguard Medical Associates, Brigham and Women's Hospital, Boston, Massachusetts
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A.L. Avins
nDivision of Research (A.L.A.), Kaiser Permanente Northern California, Oakland, California
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J.M. Schwalb
oDepartment of Neurosurgery (J.M.S., D.R.N.), Henry Ford Medical Group, Detroit, Michigan
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F.E. Diehn
pDepartment of Radiology (F.E.D.), Mayo Clinic, Rochester, Minnesota
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C.J. Standaert
qDepartment of Physical Medicine and Rehabilitation (C.J.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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D.R. Nerenz
oDepartment of Neurosurgery (J.M.S., D.R.N.), Henry Ford Medical Group, Detroit, Michigan
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T. Annaswamy
rDepartment of Physical Medicine and Rehabilitation (T.A.), VA North Texas Healthcare System, Dallas, Texas
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Z. Bauer
sCancer and Blood Disorders Center (Z.B.), Seattle Children's Research Institute, Seattle, Washington.
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D. Haynor
aFrom the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.)
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P.J. Heagerty
bComparative Effectiveness, Cost and Outcomes Research Center (J.G.J., P.J.H., J.L.F.)
fBiostatistics (P.J.H.)
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J.L. Friedly
bComparative Effectiveness, Cost and Outcomes Research Center (J.G.J., P.J.H., J.L.F.)
gRehabilitation Medicine (J.L.F.), University of Washington, Seattle, Washington
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Abstract

BACKGROUND AND PURPOSE: Epidural steroid injections may offer little-to-no short-term benefit in the overall population of patients with symptomatic spinal stenosis compared with lidocaine alone. We investigated whether imaging could identify subgroups of patients who might benefit most.

MATERIALS AND METHODS: A secondary analysis of the Lumbar Epidural Steroid Injections for Spinal Stenosis prospective, double-blind trial was performed, and patients were randomized to receive an epidural injection of lidocaine with or without corticosteroids. Patients (n = 350) were evaluated for qualitative and quantitative MR imaging or CT measures of lumbar spinal stenosis. The primary clinical end points were the Roland-Morris Disability Questionnaire and the leg pain numeric rating scale at 3 weeks following injection. ANCOVA was used to assess the significance of interaction terms between imaging measures of spinal stenosis and injectate type on clinical improvement.

RESULTS: There was no difference in the improvement of disability or leg pain scores at 3 weeks between patients injected with epidural lidocaine alone compared with corticosteroid and lidocaine when accounting for the primary imaging measures of qualitative spinal stenosis assessment (interaction coefficients for disability score, −0.1; 95% CI, −1.3 to 1.2; P = .90; and for the leg pain score, 0.1; 95% CI, −0.6 to 0.8; P = .81) or the quantitative minimum thecal sac cross-sectional area (interaction coefficients for disability score, 0.01; 95% CI, −0.01 to 0.03; P = .40; and for the leg pain score, 0.01; 95% CI, −0.01 to 0.03; P = .33).

CONCLUSIONS: Imaging measures of spinal stenosis are not associated with differential clinical responses following epidural corticosteroid injection.

ABBREVIATIONS:

AP
anteroposterior
ESI
epidural steroid injection
ML
mediolateral
NRS
numeric rating scale
RDQ
Roland-Morris Disability Questionnaire
  • © 2019 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 40 (5)
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F.A. Perez, S. Quinet, J.G. Jarvik, Q.T. Nguyen, E. Aghayev, D. Jitjai, W.D. Hwang, E.R. Jarvik, S.S. Nedeljkovic, A.L. Avins, J.M. Schwalb, F.E. Diehn, C.J. Standaert, D.R. Nerenz, T. Annaswamy, Z. Bauer, D. Haynor, P.J. Heagerty, J.L. Friedly
Lumbar Spinal Stenosis Severity by CT or MRI Does Not Predict Response to Epidural Corticosteroid versus Lidocaine Injections
American Journal of Neuroradiology May 2019, 40 (5) 908-915; DOI: 10.3174/ajnr.A6050

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Lumbar Spinal Stenosis Severity by CT or MRI Does Not Predict Response to Epidural Corticosteroid versus Lidocaine Injections
F.A. Perez, S. Quinet, J.G. Jarvik, Q.T. Nguyen, E. Aghayev, D. Jitjai, W.D. Hwang, E.R. Jarvik, S.S. Nedeljkovic, A.L. Avins, J.M. Schwalb, F.E. Diehn, C.J. Standaert, D.R. Nerenz, T. Annaswamy, Z. Bauer, D. Haynor, P.J. Heagerty, J.L. Friedly
American Journal of Neuroradiology May 2019, 40 (5) 908-915; DOI: 10.3174/ajnr.A6050
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