There is a large population of patients with lumbosacral radicular pain due to spinal stenosis who do not respond to physical therapy or oral medication management, yet wish to avoid spinal surgery or are simply not candidates due to medical co-morbidity. Given the natural history of lumbar spinal stenosis, these patients typically suffer from chronic pain and disability. Currently, the typical treatment for this population is serial corticosteroid injection. The efficacy of the treatment specifically for the indication of spinal stenosis is in question and is associated with both concerning chronic sequelae and the risk, although low, of catastrophic neurologic compromise. Alternatively, hAF is a promising new biologic treatment with neuro-protective and regenerative properties. Early studies demonstrate its anti-inflammatory properties, with high levels of anti-inflammatory cytokines, in addition to its ability to assist with regeneration of peripheral nerves. Furthermore, it has a favorable side-effect profile without concern for long-term sequelae or potential for neurologic compromise. The present study aims to determine if epidural injection of hAF compared to the corticosteroid dexamethasone is more effective for the treatment of lumbosacral radicular pain due to spinal stenosis, as measured by pain, disability, psychological function, oral analgesic use, and avoidance of surgery. Evidence for superiority of epidural hAF compared to dexamethasone injection would change the treatment paradigm for refractory radicular pain due to spinal stenosis. Furthermore, even if shown to be non-inferior to epidural dexamethasone, epidural hAF would be favored given its superior safety profile. Thus, this research has the potential to improve outcomes and patient safety in a very large population with chronic pain.
Who can participate
Age range18 Years
SexALL
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Inclusion criteria
✓. Patients who are ≥ 18 years old
✓. Pain in the low back and lower extremity (pain NRS \>4) with buttock/leg pain \> back pain.
✓. Radicular distribution of leg pain based on history and correlation with advancing imaging. Radicular pain may be fixed or claudicatory in nature.
✓. Pain resistant to a trial of conservative therapy (i.e. oral steroids, NSAIDs, opioids, muscle relaxants, physical therapy, chiropractic or other non-invasive care) for at least 3 months.
✓. Mild-moderate-severe lumbar foraminal or subarticular zone stenosis, and/or mild-moderate central canal spinal stenosis identified by MRI or CT scan according to radiologic criteria (Boden 1996).
✓. Ability to read English and complete the assessment questionnaires.
✓. Must have been 90 days since last steroid injection.
Exclusion criteria
✕. Patients in the opinion of the treating investigator who are unwilling or unable to comply with study procedures.
What they're measuring
1
The number of adverse events associated with the drug injection.
Timeframe: 2 years
2
The percentage of participants reporting >50% improvement in NRS pain score at 3 months; back and leg pain separately.
. Systemic infection or local infection over planned injection site.
✕. Bleeding disorder, current use of anticoagulants or anti-platelet medications.
✕. Intrinsic spinal cord lesions.
✕. History of central neurologic, cerebrovascular, demyelinating or muscular disease.
✕. Severe vascular, pulmonary or coronary artery disease that limits ambulation including recent myocardial infarction (within the last 6 months).
✕. Allergy to medications being used for injection procedures.
✕. Women who are pregnant, breastfeeding, or plan to become pregnant while participating in the study. If of child-bearing potential, unwillingness to use effective birth control while participating in the study.