A comparison between effectiveness of gluteal trigger point and epidural steroid injection in lumbosacral canal stenosis patients: a randomized clinical trial

Abstract

Background

Lumbosacral Spinal Stenosis (LSS) is a degenerative spine disease and a major cause of pain and disability, especially in geriatrics. Primary symptom control in patients with LSS includes conservative treatment and non-surgical methods. In this study, we aimed to compare the effect of steroid injection via epidural and gluteal trigger point techniques.

Methods

Patients aged 40–75 years old who had pain and other clinical signs of spinal stenosis in the last 6 months were included in our study and divided into two groups of gluteal trigger point (TP) or epidural steroid injection (ESI). The patients were evaluated based on the visual analog scale (VAS), Roland-Morris Disability Questionnaire (RDQ), Oswestry Disability Index (ODI), and the Quebec back pain disability scales during their pre-injection period and 2 weeks after follow-ups till 8 weeks. A P value of less than 0.05 was considered significant.

Results

A total of 44 patients were included in our study. The TP group had a significant decrease in comparison with their follow-ups; however, in the epidural group, the significant decrease was only observed compared to the pre-injection period and the scores did not have any significant decreases after the second week regarding the ODI, RQM, and VAS scales. The TP group demonstrated significantly higher scores of decreases of ODI and Quebec score compared to the epidural group at weeks 4 and 8. Regarding RQM, the TP groups demonstrated significantly higher scores of decreases compared to the epidural group at weeks 2, 4 and 8. (p < 0.001 p = 0.008, and p < 0.001, respectively).

Conclusion

Both epidural and TP steroid injection significantly reduced the patients’ pain and improved their QoL and function; however, more satisfactory results were observed in the TP group during the patients’ follow-ups, while the epidural group demonstrated only statistically significant improvement during the short-term follow-up.

Keywords:

• Trigger point
• lumbar stenosis
• steroid
• randomized clinical trial

Acknowledgment

This manuscript was a part of the thesis of Dr. Sana Khoshnazar (NO. 19631) that was approved by the vice-chancellor of research, Shiraz University of Medical Sciences, Shiraz, Iran. The study method was approved by the Medical Ethics Committee of Shiraz University of Medical Sciences (SUMS) with the reference number ‘IR.SUMS.MED.REC.1398.221’. This study was registered in the Iranian registry of clinical trials (trial number: IRCT20190802044411N1). The authors would like to thank the center for the development of clinical research of Nemazee hospital and Dr. Nasrin Shokrpour for editorial assistance, Dr. Parisa Chamanpara, and the research consultation center (RCC) of Shiraz University of medical sciences, Shiraz, Iran for statistical analysis.

Ethics approval and consent to participate

The study method was approved by the Medical Ethics Committee of Shiraz University of Medical Sciences (SUMS) with the reference number ‘IR.SUMS.MED.REC.1398.221’. This study was registered in the Iranian registry of clinical trials (trial number IRCT20190802044411N1; Date: 26-11-2020; Available at: www.irct.ir). Written informed consent form was obtained from all the participants enrolled in this trial. All patients' information was de-identified and documented confidentially, and the patients were able to exit any time during the trial if they desired. All ethical principles of the Declaration of Helsinki were considered in this trial.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

SPSS data of the participants can be requested from the authors. Please write to the corresponding author if you are interested in such data.