175: THE EFFECTIVENESS OF INTERLAMINAR LUMBAR EPIDURAL STEROID INJECTION IN LUMBAR CANAL STENOSIS

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Lumbar canal stenosis is a common cause of chronic low back pain in older adults and frequently presents with neurogenic claudication, resulting in significant functional limitation. Interlaminar lumbar epidural steroid injection (ILESI) has been proposed as a minimally invasive treatment option for patients who do not respond adequately to conservative therapy before surgical intervention is considered. In addition to its anti-inflammatory effects, ILESI may also provide mechanical benefits by facilitating the release of the epidural space and reducing the risk of re-adhesion. This study aimed to evaluate the clinical effectiveness of C-arm–guided ILESI in patients with lumbar canal stenosis.

Methods: This case series included 11 patients aged 50–76 years who presented with neurogenic claudication and a positive shopping cart sign or stoop test. All patients had previously undergone conservative management without significant clinical improvement. Baseline pain intensity and neuropathic pain characteristics were assessed using the Numeric Pain Rating Scale (NPRS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). All patients underwent C-arm–guided interlaminar lumbar epidural steroid injection. Pain intensity, functional improvement, and procedural complications were assessed at post-procedural follow-up on day 1 and during outpatient clinic visits between days 5 and 7.

Results: Among 11 patients, the mean age was 60.9 years, with 6 males (54.5%) and 5 females (45.5%). LANSS assessment indicated neuropathic pain characteristics in all patients. Pre-procedural pain intensity showed high baseline pain scores (NPRS 7–9/10; mean 8.09). Radiological evaluation showed lumbar spinal stenosis at L5–S1 in 6 patients (54.5%) and at L4–L5 in 5 patients (45.5%). Degenerative disc disease was identified in 7 patients (63.6%), while ligamentum flavum thickening was observed in 4 patients (36.4%). Following the ILESI procedure, all patients demonstrated a reduction of more than 50% in NPRS scores at day 1 follow-up (NPRS 1–4/10; mean 2.04), accompanied by improved post-procedural mobility. Sustained pain reduction was observed during outpatient follow-up between days 5 and 7 (NPRS 1–3/10; mean 1.40). No procedural complications were observed.

Conclusions: C-arm–guided ILESI demonstrated a significant pain reduction and functional improvement without procedural complications. This minimally invasive intervention may serve as a therapeutic option prior to surgical treatment in patients with lumbar canal stenosis refractory to conservative therapy.

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Presenting Author: Stefani Luziani
Submitting Author: Stefani Luziani

Senior Author: I Made Phala Kesanda

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• I Made Phala Kesanda: MD, Neurologist - Department of Neurology, Buleleng General Hospital, Buleleng, Bali, Indonesia
• I Komang Arimbawa: MD, Neurologist - Department of Neurology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia