By Dr. Michael Cicchetti and three others
Recently The Buffalo News reported on a new study of epidural steroid injections in patients with spinal stenosis that was published in the New England Journal of Medicine.
The physicians at Buffalo Spine and Sports stand by the procedures we offer to our patients. These procedures include epidural steroid injections that this article addressed.
We strongly feel that design of the Journal study and conclusions drawn from it are flawed for several reasons:
• First and foremost, any and all procedures are never used as standalone treatments in our practice, but are used to provide a window of opportunity for introduction of other treatments.
• The study included only patients with spinal stenosis, and acknowledged that epidural steroid injections have been effective for other spinal conditions such as disc herniations. In fact spinal stenosis patients make up just one group of the patients that derive benefit from epidural steroid injections.
• Spinal stenosis can affect different parts of the spine and there are different injection approaches used for each of the types. This study only mentioned one type of spinal stenosis, specifically, central stenosis, and made no mention of other types of stenosis.
Based on this fact alone, the only conclusion that can be made from this study is that epidural injections have a questionable value for patients with central spinal stenosis. This is very different from reports suggesting that this injection doesn’t work for any painful spine conditions.
• Different types of epidural injections were performed, and no attempt was made to establish which type of injection was more effective. In this study, injection approaches chosen by some doctors would not be optimal. Thus, a poor outcome can result because the incorrect technique was used.
• There was no control for the type of steroid used. Several studies show that certain steroids are more effective for epidural injections then others.
• There was no mention of dye used to ensure proper placement of the injections in the epidural space. Injection accuracy is severely compromised without using contrast. This often results in poor results. Many pain specialists are still performing epidural injections without the use of dye.
• No distinction was made between radiologists, anesthesiologists or physiatrist injectionists. A physician’s training often dictates which technique, which steroid and which level to use. By not controlling for these differences, the conclusions from this study are compromised.
Please feel free to discuss this further with our providers.
Michael Cicchetti, M.D., Corine Cicchetti, M.D., Frederick McAdam, M.D., and Leonard Kaplan, M.D., are doctors at Buffalo Spine and Sports Medicine.