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The Efficacy to Delay the Surgical Need by Transcaudal Epidural Steroid Injection in Degenerative Lumbar Spinal Stenosis with and without Listhesis: 7-Year Retrospective Study

Chaichankul C , Chaichankul C , Srisook P , Uttamo N

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Chaichankul C, Chaichankul C, Srisook P, Uttamo N. The Efficacy to Delay the Surgical Need by Transcaudal Epidural Steroid Injection in Degenerative Lumbar Spinal Stenosis with and without Listhesis: 7-Year Retrospective Study. J Med Assoc Thai 2017;100:990.

Background: Currently, epidural steroid injection (ESI) is considered as one of conservative treatments for degenerative lumbar spondylosis. Transcaudal epidural steroid injection (CESI), which is one of ESI techniques, has a lot of evidence to support the treatment of chronic low back pain with or without radiculopathy, both for short- and long-term. Presently, there are few studies about the efficacy of CESI to delay the surgical need in degenerative lumbar spinal stenosis (DLSS) with or without listhesis.

Objective: To demonstrate and compare the efficacy of CESI in treating DLSS with and without listhesis.

Material and Method: The present retrospective study analyzed the patients treated by CESI between June 2008 and May 2015 in a single institute. The medical records of the patients diagnosed as DLSS with and without listhesis were reviewed. The demographic data and the end result demonstrating as surgical need of the enrolled patients were collected and analyzed by using one-way ANOVA and Fisher’s exact test. Chi-square test and Mann-Whitney U test were used to evaluate and compare age, sex, rate of operation, and the time period to operate after the last CESI was performed, between the two groups of patients.

Results: Seven hundred forty six CESIs had been performed between June 2008 and May 2015. Six hundred fifty five CESIs were performed in 414 patients of DLSS with and without listhesis, whereas 91 CESIs were performed in 75 patients of other diagnoses. Three hundred seventy two CESIs were done in 268 cases of DLSS without listhesis (120 males, 148 females, median age = 64 years) and 283 CESIs were done in 146 cases of DLSS with listhesis (36 males, 110 females, median age = 66 years). The data demonstrated that the patients diagnosed as DLSS with listhesis had a statistically significant tendency to occur in female than the patients of DLSS without listhesis (p<0.001). Seventeen cases of DLSS without listhesis (17/268, 6.34%) and 30 cases of DLSS with listhesis ended in an operation (30/146, 20.55%), during the seven years study. Rate of operation in DLSS with listhesis after CESI was more statistically significant than in those DLSS without listhesis (p<0.001).

Conclusion: CESI is an effective conservative treatment for DLSS with and without listhesis. The present study demonstrated that CESI statistically significant delayed the time of operation and reduced the surgical need in patients diagnosed as DLSS without listhesis when compared to patients with listhesis over a period of seven years.

Keywords: Degenerative lumbar spinal stenosis, Degenerative lumbar spondylolisthesis, Transcaudal technique, Epidural steroid injection, Surgical need, Efficacy

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