Dr. Jonathan Lewin Steroid Injection Surgeon Response

A September 2015 issue of the Annals of Internal Medicine outlined a study entitled, “Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis”.

In this study, the researchers combined data from 30 placebo-controlled studies of epidural steroid injections for radiculopathy (back pain that radiates to the legs) and eight studies of spinal stenosis (back or neck pain caused by narrowing of the spinal canal).

The study showed that radiculopathy injections provided some short-term pain relief, but over time they were no more likely to be helpful than placebos, and they did not reduce the need for later surgery.

The pooled data showed similar results with injections for spinal stenosis — some moderate temporary pain relief, but no differences between treatment and placebo in pain intensity or functional ability lasting six weeks or longer after the shot.

The study lists the following conclusion: Epidural corticosteroid injections for radiculopathy were associated with immediate reductions in pain and function. However, benefits were small and not sustained, and there was no effect on long-term surgery risk. Limited evidence suggested no effectiveness for spinal stenosis.

The following is a counterpoint from Dr. Jonathan Lewin of the Center for Spinal Disorders.

Dr. Jonathan Lewin’s Response to News Articles From New York Times and U.S. News Concerning Steroid Shots, “No Better for Back Pain Than Placebo“.

“Recent news articles, including the New York Times, have outlined the findings of a published review in the Annals of Internal Medicine, in which researchers concluded from a combined combing of 30 placebo controlled studies of epidural steroid injections and their usefulness that the steroid injection shots are no better than a placebo for back pain.

From the surgeon’s standpoint, we have long viewed the published results of the efficacy of epidural steroids with some degree of question. Published results of a 75 percent finding of 50 percent reduction of pain do not mimic the experiences of most surgeons in their private practice. Of course, the surgeon often sees a combination of the more difficult or the failed cases, so certainly our opinions may be skewed. Our feeling is that epidural steroids do have a role in the management of spinal stenosis, even if that role is not a finalizing or curative role, but rather a temporizing one.

Many patients are not surgical candidates by virtue of their pathology or their comorbidities, so in that setting even a temporary relief or a partial relief lasting six to 12 weeks can be beneficial to the patient. Simply said, we cannot always get a homerun, but a single is often not a bad hit. Furthermore, we have all seen the unexpected homerun in which a patient who was sent for epidural steroids with a moderate degree of stenosis feels entirely better and never does come in for a surgery – although that percentage is small.

In summary, as most modalities in medicine, epidural steroids have a use, an appropriate use and an inappropriate use. The balanced team and practitioner will be able to strike the balance of when or when not to call a hammer a hammer and a nail a nail.

We pride ourselves at the Center for Spinal Disorders in offering a comprehensive team approach of non-operative treatment and injection as well as surgical therapy so that there is no need to prolong a treatment, which is not working. However, we feel no reason not to attempt modalities if they seem appropriate for a given patient, setting and pathology.

Looking forward to helping, and wishing everyone the best of spinal health.”

Jonathan Lewin, MD
August 25, 2015

For an additional response from Dr. Simhaee of the Center for Pain Management, click here.