Single dose epidural methylprednisolone as a treatment and predictor of outcome following subsequent decompressive surgery in degenerative lumbosacral stenosis with foraminal stenosis

• Published in: The veterinary journal (1997) 2020-03, Vol.257, p.105451-105451, Article 105451
• Main Authors: Gomes, S.A., Lowrie, M., Targett, M.
• Format: Article
• Language: English
• Subjects: Animals; Anti-Inflammatory Agents - administration & dosage; Cauda equina; Decompression, Surgical - veterinary; Dog; Dog Diseases - drug therapy; Dog Diseases - surgery; Dog Diseases - therapy; Dogs; Female; Foraminotomy; Injections, Epidural - veterinary; Intervertebral Disc Degeneration - drug therapy; Intervertebral Disc Degeneration - veterinary; Male; Methylprednisolone - administration & dosage; Neuroprotective Agents - administration & dosage; Quality of Life; Spinal Stenosis - drug therapy; Spinal Stenosis - veterinary; Spinal surgery; Treatment Outcome; Veterinary
• ISSN: 1090-0233; 1532-2971
• DOI: 10.1016/j.tvjl.2020.105451

•Epidural steroid injection (ESI) effects may show relapse within two months.•Single ESI provided long-term resolution of clinical signs in some dogs (15.6%).•ESI appeared inferior to surgery according to clinical and owner perceived outcome.•Clinical response to ESI did not predict surgical outcome.•ESI can address lumbar radiculopathy, particularly when surgery is not an option. Alternative treatments to surgery in canine degenerative lumbosacral stenosis (DLSS) remain limited and reliable predictors of outcome are lacking. The aims of this clinical trial were threefold: to assess the usefulness of single epidural steroid injection (ESI) in DLSS, to compare the outcomes of ESI and decompressive surgery, and evaluate ESI as a predictor of outcome following decompressive surgery. Dogs diagnosed with DLSS were prospectively recruited and administered an ESI. If clinical signs persisted or relapsed, decompressive surgery was recommended. Follow-up was obtained. Thirty-two dogs underwent ESI with 17 having subsequent surgery. Improvement after ESI was seen in 27/32 dogs (84.4%), with 17/22 (77.2%) relapsing within 6 months (n = 15/17 relapsing within 2 months). Five dogs failed to respond to ESI and another five (15.6%) presented a persistent post-ESI favourable response (mean follow-up time, 9.4 months). Post-surgical improvement occurred in all dogs. Outcome appeared more favourable following surgical decompression, with a trend towards reduced pain, increased mobility, and greater quality of life score. This study was unable to demonstrate that ESI could predict surgical outcome. ESI was confirmed as an effective treatment in most but not all cases, leading to transient alleviation of clinical signs for longer than previously reported. ESI provided a complete and apparently long-term sustained resolution of clinical signs in a subset of dogs. Despite this, there was indication that surgical decompression can lead to a more favourable outcome. Epidural steroid injection has a role in the management of DLSS dogs, particularly when surgery is not an option.