Survey on Spinal Injections for lumbar degenerative stenosis among spine surgeons in Latin America

Author(s): Marcelo Molina, Ramon Torres, Ratko Yurac, Samuel Pantoja, Lucio Gonzales

Introduction:

Epidural and facet joint injections are usually used as part of the treatment algorithm for low back and radicular pain. Current clinical practice in Latin America is not well described in the literature.

Objectives:

Evaluate the indications and techniques of spinal injections (SI) in patients with degenerative lumbar spinal stenosis (DLSS) among spine surgeons in Latin America.

Study Design:

Cross-sectional, international survey, narrative literature review.

Methods:

An online survey was sent to spine surgeons and members of the AOSpine Latin America. Data included surgeon geographic information, specialty, time in professional activity, SI indications, and techniques in different scenarios of pain and stenosis localization.

Results:

A total of 446 surgeons, 291 (65%) orthopedic surgeons, and 155 (35%) neurosurgeons replied to the survey. 92% of spine surgeons indicated a spinal steroid injection to treat DLSS. Most spinal surgeons (54%) would simultaneously perform both peridural and intraarticular lumbar facet (combined) steroid injections in patients with low back pain and radicular pain. Foraminal injection is a preferred technique for patients with central and foraminal stenosis. There are no significant differences in most of the answers between orthopedic surgeons and neurosurgeons. Almost 80% of respondents expect a good result from the injection. However, 86% of surgeons believe injection effects last less than 6 months, and only 12% think surgery will not be necessary in the future. Only 15% of spine surgeons irrespective of specialty adhere to a guideline on spine injections for DLSS.

Conclusion:

This study provides a global perspective on how Latin American spine surgeons treat patients with DLSS concerning the use of spinal steroid injections. We observed that more than 90% of respondents use this procedure to treat DLSS. There are almost no differences between orthopedic spine surgeons and neurosurgeons when performing SI. A foraminal injection is preferred for lateral recess and foraminal stenosis. Most of the respondents expect to achieve positive results with the procedure, but they believe that its effect will last for less than 6 months and possible need for surgery.