Efectos sistémicos de las inyecciones epidurales de esteroides para la estenosis del canal.: Publicado originalmente en la Revista PAIN 2018; 159: 876-83. Traducción: Ariel Francis.

Janna L. Friedly; Bryan A. Comstock; Patrick J. Heagerty; Zoya Bauera; Micol S. Rothman; Pradeep Suri; Ryan Hanen; Andrew L. Avins; Srdjan S. Nedeljkovic; David R. Nerenz; Venu Akuthota; Jeffrey G.  Jarvik

doi:10.47924/neurotarget2018127

Authors

Janna L. Friedly Centro de Investigación de costos, efectividad y evolución, comparativos de la Universidad de Washington, Seatle, WA, USA.
Bryan A. Comstock Centro de Investigación de costos, efectividad y evolución, comparativos de la Universidad de Washington, Seatle, WA, USA.
Patrick J. Heagerty Centro de Investigación de costos, efectividad y evolución, comparativos de la Universidad de Washington, Seatle, WA, USA.
Zoya Bauera Centro de Investigación de costos, efectividad y evolución, comparativos de la Universidad de Washington, Seatle, WA, USA.
Micol S. Rothman Departamento de Medicina, Universidad de Colorado, Aurora, CO, USA.
Pradeep Suri Departamento de Terapias Física y de Rehabilitación. Universidad de Colorado, Aurora, CO, USA.
Ryan Hanen Departamento de Farmacia, de la Universidad de Washington, Seatle, WA, USA.
Andrew L. Avins Centro permanente de investigación en Salud Kaiser, Portland Oregon, USA.
Srdjan S. Nedeljkovic Centro permanente de investigación en Salud Kaiser, Portland Oregon, USA.
David R. Nerenz Radiología de la Universidad de Washington, Seatle, WA, USA.
Venu Akuthota Radiología de la Universidad de Washington, Seatle, WA, USA.
Jeffrey G. Jarvik Radiología de la Universidad de Washington, Seatle, WA, USA.

DOI:

https://doi.org/10.47924/neurotarget2018127

Keywords:

Lumbar spinal stenosis, Corticosteroid, Epidural steroid injection, Back pain, Cortisol suppression, Systemic effects

Abstract

This analysis of the lumbar epidural steroid injections for spinal stenosis multicenter randomized controlled trial data identifies thedegree of and risk factors for cortisol suppression after epidural steroid injections in older adults with spinal stenosis. Four hundredpatients aged 50 years and older with back or leg pain and central lumbar spinal stenosis completed baseline demographic andpsychosocial measures. Morning serum cortisol levels were measured at baseline and 3 weeks after initial injection. Patients were
randomized to receive epidural injections of either local anesthetic with corticosteroid (n 5 200) or local anesthetic only (n 5 200).The specific corticosteroid was chosen at the treating physician’s discretion (methylprednisolone, betamethasone, triamcinolone, ordexamethasone). Thirty-two patients (20.3%) treated with corticosteroid experienced cortisol reduction at 3 weeks of .50%compared with 10 patients (6.7%) treated with lidocaine only (adjusted treatment effect53.5, 95% confidence interval: 1.6-7.9, P5
0.002). The effect on 3-week cortisol changes did not differ by demographic or patient-level characteristics. Those treated withmethylprednisolone or triamcinolone had an average 3-week cortisol reduction of 41.0% (P 5 0.005) and 41.6% (P , 0.001) frombaseline, respectively, whereas patients treated with betamethasone or dexamethasone were not significantly different thancomparable patients in the lidocaine arm. The higher rates of cortisol suppression at 3 weeks in those receiving epiduralcorticosteroid injections, particularly with longer-acting insoluble corticosteroid formulations, are consistent with sustained systemicabsorption of corticosteroid.

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