Background and Aims Lumbar central spinal stenosis(LCSS) is debilitating disorder with spine degeneration that results in disability and persistent chronic pain.

Methods Randomized controlled study compares efficacy of conservative therapy(CT), interlaminar epidural steroid injections(IESI) and their both combination(CT+IESI). Primary outcomes included pain(Numeric Pain Rating Score (NRS)), disability(Oswestry Disability Index (ODI)) and quality of life(European Quality of Life Questionnaire). Outcomes analysed as short-term(≤ 3 months), intermediate-term(3 to 6 months), long-term(6 months to 1 year). Patients included with NRS ≥ 7.

Results 229 patients with symptomatic LCSS randomly assigned to CT, IESI, CT+IESI group: 87(age 63±9), 82(age 57±9) and 60 patients(age 61±6), respectively. Mean physical function improvement for CT, IESI, CT+IESI groups 19.2 (95% confidence interval (CI)13.6 to 24.8), 22.4 (95% CI 16.9 to 27.9) and 26.7 (95% CI 21.5 to 32.7), respectively. IESI valuable for pain relief at short-term (MD 1.23, 95% CI 0.54-1.89; P=0.0002), CT+IESI at long-term (MD 0.85, 95% CI 0.46-1.24; P<0.0001)compared with CT. There were no statistically significant differences in functional improvement after CT and IESI at short-term and intermediate-term follow up (MD 3.65, 95% CI 2.24-5.06; P=0.21), long-term functional improvement observed in CT+IESI group (MD 0.81, 95% CI 0.48-1.14; P<0.0001). Patients‘ satisfaction with treatment was significantly higher in CT+IESI group (MD 1.30, 95% CI 1.12-1.48; P<0.0001).

Conclusions Use of combined CT+IESI therapy is more effective for relieving severe chronic LCSS pain than each of these therapy methods separately at long- term. Patients noticed more successful outcomes receiving CT+IESI. This study might help clinicians to make decisions for severe pain treatment of patients with LCSS.

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