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 candidates for surgery 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.
At that time, 29 of the 55 patients avoided surgery. Dr. Riew, a professor of orthopedic surgery at Washington University in St. Louis, and his colleagues contacted these patients 5 years post injection, and 21 responded.
Of the 21 who responded, 9 patients had been injected with only the local anesthetic; of those patients, 8 had avoided surgery during the intervening years. Twelve of the patients who responded had received 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 seemed to be no difference in outcomes between the two groups.
All the patients had significant decreases in symptoms and back pain at 5-year follow-up. Dr. Riew recommended that patients with nerve root pain who are without significant neurologic symptoms be offered nerve root blocks before surgical intervention.