The Efficacy of Epidural Depo-Methylprednisolone And Triamcinolone Acetate In Relieving The Symptoms Of Lumbar Canal Stenosis: A Comparative Study

Objective: To compare the efficacy of depo-methylprednisolone and triamcinolone acetate in pain relief and in the improvement in claudication distance after two doses of epidural injections in patients with clinically diagnosed lumbar canal stenosis. Material and Methods : This prospective, randomized trial was performed in seventy patients with the clinical features of lumbar canal stenosis, who received epidural medications for pain relief. The patients were grouped into two; the T group receiving an injection of 80mg triamcinolone acetate with bupivacaine (0.125%) diluted in normal saline and the M group receiving 80 mg methylprednisolone acetate with bupivacaine (0.125%) diluted in normal saline solution (total volume of 20 ml in each group). The pain relief was assessed at 1, 3 and 6 months post-procedurally for improvement in the VAS pain scores and for the increase in the claudication distance. Results: Of the 70 patients who were included in the study, 40% were females (n=28) and 60% were males (n=42). In the M group, 24 patients (68.5%) reported improvement in the VAS pain scores at the end of 6 months, as compared to 14 (40%) patients in the T group. The pre-intervention mean claudication distance was 163 meters in the group M and 170 meters in the group T, which improved to 637 metres and 350 meters in groups M ( P 0.05) respectively, at the end of a 6 month follow up. In group M, the average VAS scores decreased from 7.34 in the pre-treatment phase, to 3.64 at the end of a 6 month follow up, which was significantly low ( P=0.02). Comparatively, in group T the pre-treatment VAS score value decreased from 6.4 to 4.8 after 6 months of treatment ( P< 0.05). Conclusion : Both triamcinolone and methylprednisolone are effective epidural medications for symptomatic relief in lumbar canal stenosis, though depomethylprednisolone showed better long term pain relief and improved walking distance at long term intervals as compared to triamcinolone.