Epidural Steroid Injection Versus Epidural Steroid Injection and Manual Physical Therapy and Exercise in the Management of Lumbar Spinal Stenosis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00786981
Recruitment Status : Active, not recruiting
First Posted : November 6, 2008
Last Update Posted : February 7, 2018
University of Colorado, Denver
Information provided by (Responsible Party):
Joshua Cleland, DPT, OCS, Franklin Pierce University

Brief Summary:
Lumbar spinal stenosis (LSS) is a prevalent and disabling condition in the rapidly growing aging population. People with LSS often have a substantial physical and psychosocial burden as well as significant healthcare costs affecting both the individual and society. It has been reported that patients with LSS over the age of 65 are more likely to undergo spinal surgery than any other condition with an estimated total annual inpatient expense of one billion. Individuals undergoing surgical treatment for LSS tend to be older, therefore operative morbidity and mortality are a particular concern. Functional benefit derived from conservative treatment may increase the health and quality of life for individuals suffering from LSS and avoid or delay the need for surgery in some subjects. As the population continues to age, identifying effective non-surgical treatment options for older patients with LSS is an important research priority. Ultimately, the information gained from this study will help fill a significant void in medical literature regarding non-surgical options for this patient population.

Condition or disease Intervention/treatment Phase
Lumbar Spinal Stenosis Other: Epidural steroid injection plus physical therapy Other: Epidural steroid injection Not Applicable

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 80 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Epidural Steroid Injection Versus Epidural Steroid Injection and Manual Physical Therapy and Exercise in the Management of Lumbar Spinal Stenosis; a Randomized Clinical Trial
Study Start Date : April 2009
Estimated Primary Completion Date : December 2018
Estimated Study Completion Date : December 2018

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Epidural steroid injection and physical therapy Other: Epidural steroid injection plus physical therapy
Patients in the ESI+PT Group will be treated additionally with a physical therapy program emphasizing lumbar flexion exercises, aerobic and strength/ conditioning exercises, and manual physical therapy as well as receiving up to 3 epidural steroid injection(s) and educational support using The Back Book.

Epidural steroid injection Other: Epidural steroid injection
Patients in the ESI Group will be treated with up to 3 epidural steroid injections, educational support, and general care by the treating physician.

Primary Outcome Measures :
  1. The primary outcome of interest will be change in disability as measured by the Modified Oswestry Disability Index (OSW). [ Time Frame: 10 weeks, 6 months, 12 months ]

Secondary Outcome Measures :
  1. Change in patient-reported pain [ Time Frame: 10 weeks, 6 months, 12 months ]
  2. Change in Functional Limitations [ Time Frame: 10 weeks, 6 months, 12 months ]
  3. Change in psychosocial evaluation [ Time Frame: 10 weeks, 6 months, 12 months ]
  4. Change in patient satisfaction [ Time Frame: 10 weeks, 6 months, 12 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   50 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Lumbar spinal stenosis unidentified by MRI or CT scan and interpreted by a radiologist independent of the study. The criteria of Boden et al will be used to define LSS on MRI: non-discogenic loss of signal in the epidural fat with compression of neural tissues.
  2. Chief complaint of pain in the low back, buttock, and/or lower extremity. The patient must have LE symptoms consistent with neurogenic claudiation.
  3. Patient-reported inability to walk greater than ¼ mile due to lower extremity pain and/or cramping.
  4. Rates sitting as a better position with respect to symptom severity compared to standing or walking.
  5. Consent of the patient to undergo education, epidural steroid injection(s), and attend specified physical therapy sessions.
  6. Individuals with no language barrier, that are cooperative, have transportation to the Spine Center, and who sign an informed consent form.
  7. Age greater than or equal to 50 years.

Exclusion Criteria:

  1. Patients with organic brain syndrome or dementia.
  2. Severe vascular, pulmonary or coronary artery disease which limits ambulation.
  3. Recent myocardial infarction (within last 6 months).
  4. Spondylolisthesis requiring surgical fusion (i.e., greater than 5mm of slippage).
  5. Previous spinal surgery that included fusion of two or more vertebrae.
  6. Severe osteoporosis as defined by multiple compression fractures or a fracture at the same level as the stenosis.
  7. Metastatic cancer.
  8. Excessive alcohol consumption or evidence of non-prescribed or illegal drug use.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00786981

United States, Colorado
Colorado University
Denver, Colorado, United States
United States, Illinois
Illinois Neurological Institute at OSF
Peoria, Illinois, United States, 61637
United States, Mississippi
Keesler Air Force Base
Keesler Air Force Base, Mississippi, United States, 39564
United States, South Carolina
Hawkins Foundation
Greenville, South Carolina, United States, 29615
Sponsors and Collaborators
Franklin Pierce University
University of Colorado, Denver

Responsible Party: Joshua Cleland, DPT, OCS, Professor, Franklin Pierce University Identifier: NCT00786981     History of Changes
Other Study ID Numbers: FP-36472
First Posted: November 6, 2008    Key Record Dates
Last Update Posted: February 7, 2018
Last Verified: February 2018

Additional relevant MeSH terms:
Constriction, Pathologic
Spinal Stenosis
Pathological Conditions, Anatomical
Spinal Diseases
Bone Diseases
Musculoskeletal Diseases