WASHINGTON — Local anesthetic injected into the lumbar spine, either alone or with a steroid, may help patients avoid surgery for as long as 5 years, according to a study presented by K. Daniel Riew, M.D., and colleagues at the annual meeting of the American Academy of Orthopaedic Surgeons.
The study was a follow-up of a trial they published in the Journal of Bone and Joint Surgery in 2000, in which 55 patients who were surgical candidates were randomly assigned instead to a selective nerve root injection of either bupivacaine alone or bupivacaine and betamethasone. Neither the physician nor the patient knew which was being injected. The injections were administered under fluoroscopic guidance.
At that time, 29 of the 55 patients avoided surgery. Dr. Riew and his colleagues contacted these patients 5 years post injection, and 21 responded. Of those, 9 patients had been injected with only the local anesthetic; and of those patients, 8 had avoided surgery during the intervening years. Twelve of the 21 had been injected with the anesthetic plus steroid, and 9 of those 12 had avoided surgery in the intervening years.
There was no significant difference in surgery avoidance between the patients who had the local anesthetic alone and those receiving the bupivacaine with betamethasone. Dr. Riew said the bupivacaine alone may have had a placebo effect. But, he added, the original nerve root irritation could have healed on its own.
Among the 21 responding patients, 14 had spinal stenosis and 7 had a herniated disc as the initial diagnosis. There was no difference in outcomes between these two groups. All the patients had significant decreases in neurologic symptoms and back pain at 5-year follow-up, said Dr. Riew of Washington University, St Louis.