Abstract
Purpose of Review
The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Our study was IRB-approved and included 16 patients, 68 to 83 years old, with symptomatic back and radicular leg pain secondary to lumbar stenosis. Patients could elect to undergo a lumbar ESI (n = 11) or be treated via medication management (n = 5). Numeric pain score, SPPB score, and adverse events were measured and compared at baseline and a 1-month follow-up visit.
Recent Findings
Statistically significant improvements were observed from baseline compared to the 1-month follow-up for total SPPB score in the injection group. Similar improvements in the injection group were observed for pain scores and the SPPB subcomponents such as the 4-m walk test, chair stand time, and balance score. Comparatively, no statistically significant improvements were observed in the medication group.
Summary
Lumbar ESIs improved objective physical capacity parameters and pain scores in elderly patients with symptomatic lumbar stenosis compared to medication management. In addition, the SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic.
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Funding
The authors wish to disclose and thank the sponsor of the study. The study was conducted by Dr. Rene Przkora and was sponsored by the National Institutes of Health-funded University of Texas Medical Branch (UTMB) Clinical and Translational Science Award (grant no. UL1TR001439) and by the UTMB Claude D. Pepper Older Americans Independence Center (grant no. P30 AG024832 to E.V.) Research Career Development Project (project no. RCD4 to R.P.). The sponsorship was limited to supplies and expenses. It had no influence or interference after the protocol was designed.
The financial sponsor of this work had no role in the design and conduct of the study or the collection, management, analysis, or interpretation of the data. The sponsor also did not have a role in the preparation or review of the manuscript or the decision to submit.
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The present investigation was a prospective, Institutional Review Board-approved, observational study in adults > 65 years old. Informed written consent was obtained for every patient.
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Each author certifies that he or she, or a member of his or her immediate family, has no commercial association (i.e., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript. Rene Przkora, Michael P. Kinsky, Steve R. Fisher, Christopher Babl, Christoph E. Heyde, Terrie Vasilopoulos, Alan D. Kaye, and Elena Volpi declare no conflict of interest. Alan Kaye is on the speaker bureau for Merck and Depomed, Inc.
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Przkora, R., Kinsky, M.P., Fisher, S.R. et al. Functional Improvements Utilizing the Short Physical Performance Battery (SPPB) in the Elderly after Epidural Steroid Injections. Curr Pain Headache Rep 23, 14 (2019). https://doi.org/10.1007/s11916-019-0748-2
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DOI: https://doi.org/10.1007/s11916-019-0748-2